JCEM:美国七个医学中心新冠肺炎期间1型糖尿病酮症酸中毒的趋势

2022-04-15 从医路漫漫 MedSci原创

在患有T1D并伴随新冠肺炎感染的患者中,少数种族/民族的患者更有可能出现糖尿病酮症酸中毒(DKA),这是一种常见的、危及生命的但一般可预防的糖尿病并发症,由胰岛素缺乏引起,特征是以酮的形式产生过量的酸

背景:新冠肺炎大流行对21世纪的医疗保健产生了深远的影响。对于1型糖尿病(T1D),多份报告表明,在新冠肺炎大流行期间,新诊断的T1D的症状比前几年更严重。目前的大流行也暴露了我们卫生保健系统中存在的不平等现象。在患有T1D并伴随新冠肺炎感染的患者中,少数种族/民族的患者更有可能出现糖尿病酮症酸中毒(DKA),这是一种常见的、危及生命的但一般可预防的糖尿病并发症,由胰岛素缺乏引起,特征是以酮的形式产生过量的酸。尽管新冠肺炎对医疗服务的提供产生了干扰,并且这种干扰对T1D患者构成了风险,但评估新冠肺炎大流行期间DKA趋势和最有可能受到影响的人群的研究一直有限,结果相互矛盾。

在上述背景下,T1D交易所质量改进协作体(T1DX-QI)开发了一项多中心人口健康研究,以相对于流行前比较,检查新冠肺炎大流行期间全美和整个寿命内DKA的趋势。T1DX-QI是一个不断发展的社区,美国各地的诊所参与分享数据和最佳实践,以改善糖尿病医疗保健的提供和结果。我们的目的是了解与大流行期间观察到的DKA趋势相关的因素,以推动大流行期间和之后的临床质量改进活动。

目的:我们研究了美国7个大型医疗中心在新冠肺炎大流行期间1型糖尿病(T1D)患者中糖尿病酮症酸中毒(DKA)的美国趋势及其相关因素。

方法:我们比较了2019年同期在新冠肺炎激增1(2020年3月至5月)和新冠肺炎激增2(2020年8月至10月)期间患有T1D的儿童和成人发生的DKA事件。使用描述性统计和卡方检验进行分析。

结果:我们发现2019年与2020年接受DKA的T1D患者的绝对数量没有差异。然而,2019年非西班牙裔黑人经历DKA的比例高于非西班牙裔白人(44.6%比16.0%;p<0.001),这种差异在新冠肺炎大流行期间持续存在(48.6%比18.6%;p<0.001)。与2019年相比,2020年接受持续血糖监测(CGM)或胰岛素泵治疗的患者中DKA的发生率较低(CGM:13.2%比15.0%,p<0.001;胰岛素泵:8.0%比10.6%,p<0.001)。与每年的DKA总数相比,与2019年同期相比,在新冠肺炎激增1和2期间患有DKA的患者比例更高(激增1:7.1%比5.4%,p<0.001;激增2:6.6%比5.7%,p=0.001)。

图1.新冠肺炎期间T1D患者DKA频率增加1和2。(A)2019年与2020年相比,T1D患者(新诊断的T1D和确诊的T1D)在DKA中出现的百分比。(B)2019年与2020年相比,确诊为T1D的患者在DKA就诊的比例逐月上升。P值对应于2019年与2020年新冠肺炎激增期间DKA频率的差异。

图2.与2019年相比,2020年使用CGM(A)或胰岛素泵(B)的患者中DKA较少见。(A)在DKA患者中连续使用血糖监测仪(CGM)。(B)DKA患者中胰岛素泵的使用情况。

图3.在新冠肺炎大流行的第一年,DKA的种族/族裔不平等现象持续存在。2019年和2020年按种族/民族分列的DKA患者月度百分比。2019年和2020年在DKA就诊的NHB患者的比例显著高于NHW患者(2019年和2020年比较P<0.001)或西班牙裔患者(2019年和2020年比较P=0.01)。2019年与2020年相比,每月DKA频率没有种族内差异。

结论:新冠肺炎峰期T1D患者DKA频率增加,其中NHB频率最高。DKA在使用CGM或胰岛素泵的患者中较少见。这些发现突显了迫切需要改进战略,以在T1D患者中预防DKA--不仅在大流行情况下,而且在所有情况下--特别是在受卫生不平等影响最大的人群中。

原文出处:  Lavik AR,  Ebekozien O,  Noor N,et al.Trends in type 1 diabetic ketoacidosis during COVID-19 surges at seven US centers: highest burden on non-Hispanic Blacks.J Clin Endocrinol Metab 2022 Apr 05

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    2022-04-25 achengzhao
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    2022-06-22 smallant2015
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    2022-04-15 屋顶瞄爱赏月

    学习了

    0

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    2022-04-09 mashirong
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