Diabetes Care:1型糖尿病诊断时酮症酸中毒预测长期血糖控制不佳!

2017-07-01 xing.T MedSci原创

由此可见,在儿童1型糖尿病的诊断时的DKA能够预测长期血糖控制不良,并且独立于人口学和社会经济因素。

近日,糖尿病领域权威杂志Diabetes Care上发表了一研究文章,这项研究旨在检测一个假设,即在儿童1型糖尿病诊断时的酮症酸中毒(DKA)可以独立于已知危险因素来预测长期血糖控制不佳。

这是一项对3364名科罗拉多居民在1998年至2012岁期间18岁之前诊断为1型糖尿病的患者进行的前瞻性队列研究,并随访监测了15年。其中,1297名(39%)受试者在诊断时有糖尿病酮症酸中毒(血糖>250mg/dL,静脉pH<7.3或碳酸氢根<15mEq/L)。酮症酸中毒的严重程度进一步分为轻度/中度(pH为7.10-7.29或碳酸氢钠为5-14 mEq/L)或重度(pH<7.10或碳酸氢根<5mEq/L)。糖化血红蛋白水平平均增加为2.8倍/年(中位数为20糖化血红蛋白值/患者)。线性混合模型被用来评估DKA对长期糖化血红蛋白水平的影响,调整了年龄、种族、性别、糖尿病家族史、健康保险和胰岛素泵的使用。

糖尿病诊断时的酮症酸中毒可以预测HbA1c水平持续升高。与没有DKA的儿童相比,HbA1c在严重DKA患者中要高1.4%(15.3mmol/mol)(P<0.0001)以及在诊断时为轻/中度DKA的患者要高0.9%(9.8 mmol/mol)(P<0.0001)。这些影响与少数民族状况或在诊断时缺乏健康保险无关,其能够分别预测糖化血红蛋白高出0.5%(5.5mmol/mol,p<0.0001)和0.2%(2.2 mmol/mol,P<0.0001)。胰岛素泵使用或有1型糖尿病的父母或兄弟姐妹分别能够预测长期糖化血红蛋白降低0.4%(4.4 mmol/mol,P<0.0001)和0.2%(2.2 mmol/mol;P=0.01)。

由此可见,在儿童1型糖尿病的诊断时的DKA能够预测长期血糖控制不良,并且独立于人口学和社会经济因素。

原始出处:

Lindsey M. Duca,et al. Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes Predicts Poor Long-term Glycemic Control.Diabetes Care 2017. https://doi.org/10.2337/dc17-0558

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  5. 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GetPortalCommentsPageByObjectIdResponse(id=221711, encodeId=9579221e11ef, content=文章真好,拜读了, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Thu Jul 13 08:28:48 CST 2017, time=2017-07-13, status=1, ipAttribution=)]
  6. 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  7. 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  8. 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GetPortalCommentsPageByObjectIdResponse(id=221711, encodeId=9579221e11ef, content=文章真好,拜读了, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Thu Jul 13 08:28:48 CST 2017, time=2017-07-13, status=1, ipAttribution=)]
    2017-07-25 jyzxjiangqin

    1型糖尿病诊断的注意事项。

    0

  9. 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    2017-07-15 jyzxjiangqin

    1型糖尿病的诊断。

    0

  10. 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GetPortalCommentsPageByObjectIdResponse(id=221711, encodeId=9579221e11ef, content=文章真好,拜读了, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Thu Jul 13 08:28:48 CST 2017, time=2017-07-13, status=1, ipAttribution=)]
    2017-07-13 1e10c84am36(暂无匿称)

    文章真好,拜读了

    0

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Diabetes Care: 1型糖尿病患者严重低血糖的风险-30年的随访结果!

严重低血糖的发生率在两个DCCT/EDIC研究治疗组之间随着时间而逐渐平衡,这与糖尿病病程进展和类似的HbA1c水平相关。严重低血糖的存在仍然是1型糖尿病患者的一个挑战。

JCEM:小剂量胰高血糖素治疗1型糖尿病患者非严重低血糖症的疗效和安全性如何?

低剂量胰高血糖素可以成功地治疗轻度至中度低血糖,并可能是口服碳水化合物的一种有用的替代治疗,尽量避免了不必要的热量摄入。