Pediatr Diabetes：青年T1D患者血糖控制差增加DKA风险

重度低血糖（SH）和糖尿病酮症酸中毒（DKA）是1型糖尿病（T1D）常见的严重急性并发症。为了确定在1型糖尿病交流中心的儿童和青年队列中，重度低血糖和糖尿病酮症酸中毒发生的频率，以及确定重度低血糖和糖尿病酮症酸发生有关的因素，来自美国耶鲁大学的Eda Cengiza教授及其团队进行了一项研究，该研究发现在青少年和青壮年1型糖尿病患者中，血糖控制差增加糖尿病酮症酸中毒的风险，但不能预防重度低血糖的发生。该研究结果在线发表在5月8日的《儿童糖尿病》（Pediatric diabetes）杂志上。

该研究分析了13487例1型糖尿病交流中心临床登记的、年龄2到26岁、1型糖尿病病程≥2年的受试者。在前12个月，使用独立logistic回归模型评估基线人口和临床因素与重度低血糖或糖尿病酮症酸中毒的关系

该研究发现，非白人种族、没有私人健康保险、以及较低的家庭收入与重度低血糖和糖尿病酮症酸中毒发生频率增加有关（p＜0.001）。在＜6岁的儿童中，重度低血糖发生频率最高（p=0.005），但在控制其他因素后，整个年龄范围内，重度低血糖与糖化血红蛋白A1c(HbA1c)水平无关（p=0.72）。在青少年，糖尿病酮症酸中毒发生频率最高（p＜0.001），并与较高的HbA1c有关（p＜0.001）。

该研究发现，在青少年和青壮年1型糖尿病患者中，血糖控制差增加糖尿病酮症酸中毒的风险，但不能预防重度低血糖的发生。在弱势少数民族的1型糖尿病患者中，观察到重度低血糖和糖尿病酮症酸中毒频繁出现，突出强调在这些高危人群的患者中，需要针对性干预和新的治疗模式。

Severe hypoglycemia and diabetic ketoacidosis among youth with type 1 diabetes in the T1D Exchange clinic registry.
OBJECTIVE
Severe hypoglycemia (SH) and diabetic ketoacidosis (DKA) are common serious acute complications of type 1 diabetes (T1D). The aim of this study was to determine the frequency of SH and DKA and identify factors related to their occurrence in the T1D Exchange pediatric and young adult cohort.
RESEARCH DESIGN AND METHODS
The analysis included 13 487 participants in the T1D Exchange clinic registry aged 2 to <26 yr with T1D ≥2 yr. Separate logistic regression models were used to evaluate the association of baseline demographic and clinical factors with the occurrence of SH or DKA in the prior 12 months.
RESULTS
Non-White race, no private health insurance, and lower household income were associated with higher frequencies of both SH and DKA (p < 0.001). SH frequency was highest in children <6 yr old (p = 0.005), but across the age range, SH was not associated with hemoglobin A1c (HbA1c) levels after controlling for other factors (p = 0.72). DKA frequency was highest in adolescents (p < 0.001) and associated with higher HbA1c (p < 0.001).
CONCLUSIONS
Our data show that poor glycemic control increases the risk of DKA but does not protect against SH in youth and young adults with type 1 diabetes. The high frequencies of SH and DKA observed in disadvantaged minorities with T1D highlight the need for targeted interventions and new treatment paradigms for patients in these high risk groups.