基础加餐时胰岛素治疗儿童1型糖尿病的疗效

目的 观察应用基础加餐时胰岛素治疗儿童1型糖尿病(T1DM)的临床效果.方法 15例T1DM患儿采用传统治疗方案治疗平均16个月:双时相低精蛋白锌胰岛素30/70,2/3量早餐前30 min皮下注射,1/3量晚餐前30 min皮下注射;之后采用基础加餐时治疗方案治疗至少12个月:3餐前0～15 min门冬胰岛素皮下注射,睡前甘精胰岛素皮下注射.观察基础加餐时方案治疗后糖化血红蛋白(HbA1c)水平、胰岛素用量和低血糖发生情况.结果 15例T1DM患儿应用基础加餐时胰岛素类似物治疗后3、6、9、12个月的HbA1c与传统治疗相比降低(t=7.15、4.88、3.46、5.28,Pa<0.01),3、6、9、12个月的HbA1c相互间比较差异无统计学意义(t=2.08、1.64、1.73、1.85、1.96、1.66,Pa>0.05).胰岛素用量差异无统计学意义(t=1.56,P>0.05).传统方法治疗期间,7例发生严重低血糖,改用基础加餐时胰岛素治疗方案后,无一例发生严重低血糖.发生轻中度低血糖的次数亦显著减少(t=13.31,P<0.001).结论 应用基础加餐时胰岛素治疗儿童T1DM可使患儿获得较好的血糖控制,同时减少低血糖发生,而胰岛素用量并无增加,并可改善患儿的治疗满意度及生活质量.

Primary Observation of Basal-Bolus Insulin Therapy in Children with Type 1 Diabetes Mellitus

Objective To observe the clinical effect by using a basal-bolus insulin therapy in children with type 1 diabetes mellitus(T1DM).Methods Fifteen children with T1DM used conventional regimen(premixed insulin 30/70,2/3 dose 30 minutes before breakfast,1/3 dose 30 minutes before dinner) for 16 months;then they were treated with basal-bolus insulin therapy(injection of insulin aspart 0-15 minutes before meals and a bedtime injection of insulin glargine) for at least 12 months.Glycolated hemoglobin(HbA1c) values,daily insulin dose,incidence of severe and non-severe hypoglycemia events before and after the institution of basal-bolus therapy,were collected.Results Basal-bolus therapy was associated with lower level of HbA1c at 3,6,9 and 12 months for 15 subjects of T1DM compared with conventio-nal therapy(t=7.15,4.88,3.46,5.28,Pa<0.01).No statistical difference was observed between 3,6,9 and 12 months(t=2.08,1.64,1.73,1.85,1.96,1.66,Pa>0.05).There was no clinically important change in the daily dose of insulin(t=1.56,P>0.05).During conventional therapy,severe hyperglycemia occurred in 7 cases,while using basal-bolus therapy,severe hyperglycemia didn′t happen.Incidence of severe and non-severe hypoglycemia events obviously reduced(t=13.31,P<0.001).Conclusions Institution of basal-bolus therapy is associated with improved glycemic control and decreased rates of hypoglycemia while dose of insulin did not increase.It can also improve patients′ satisfaction and quality of life.