Prevalence and Clinical Characteristics of Type I and Type II Insulin-Treated Diabetes in the Community
Prevalence and Clinical Characteristics of Type I and Type II Insulin-Treated Diabetes in the Community
复制标题
社区中 I 型和 II 型胰岛素治疗糖尿病的患病率和临床特征
DOI：
10.2337/diacare.17.10.1230
复制
发表时间：
1994
期刊：
影响因子：
16.2
通讯作者：
S. Weitzman
中科院分区：
文献类型：
--
作者：
M. Maislos;Bettina Bodner;S. Weitzman
关于成人I型糖尿病患病率的准确数据很少（1,2）。胰岛素治疗的糖尿病患者通常很难仅根据临床依据来确定是I型还是II型，特别是当患者长期接受胰岛素治疗时。正如最近所强调的，对成人I型糖尿病患病率的准确信息有持续的需求(2)。我们确定了以色列内盖夫地区I型糖尿病的患病率以及I型和II型胰岛素治疗患者的临床特征。研究了内盖夫首府比尔舍瓦的Kupat Holim疾病基金（覆盖约85%的人口）的三个社区诊所的所有已知的30岁糖尿病患者（胰岛素和非胰岛素治疗）。根据空腹血浆c肽水平将胰岛素治疗患者分为I型和II型患者（3,4）。数据来自个人访谈、患者医疗记录、体格检查和实验室分析。血液化学检测采用自动化方法（SMA）。检测所有患者的血浆c肽水平。内源性胰岛素分泌结果<0.132 nmol/1为阴性，>0.265 nmol/1为阳性（6,7）。在非诊断结果（c肽在0.132和0.265 nmol/1之间）的情况下，进行胰高血糖素试验（8,9）；平缓反应被认为是内源性胰岛素分泌阴性。从每位受试者的问卷调查、体格检查和实验室获得的数据被编码并存储。均值之间的差异使用学生t检验计算。以I型和II型胰岛素治疗患者的合并人群为标准，对合并症和糖尿病并发症的患病率进行年龄调整。该研究的目标人群包括9,573名30岁以下的成年人；588名受试者（占研究人群的6.1%）患有糖尿病；100例患者（占研究人群的1.0%）接受胰岛素治疗；96名患者（36名男性，60名女性）同意参加研究。在所有已知的糖尿病患者中，17%（588人中有100人）接受了胰岛素治疗。在所有接受胰岛素治疗的患者中，只有25%（96名患者中的24名）患有胰岛素缺乏型1型糖尿病（低肽水平）。因此，以色列内盖夫地区成人I型糖尿病患病率为2.5:1,000（9,573人中有24人）。表1包含了I型和II型胰岛素治疗患者的年龄、糖尿病诊断时的年龄、糖尿病诊断时的首次治疗、血液实验室参数、糖尿病并发症和合并症（如高血压、高脂血症、冠状动脉疾病、视网膜病变和蛋白尿）的数据。据我们所知，这是第一次在以色列进行基于空腹血浆c肽水平测定的成人I型糖尿病患病率的综合研究。以色列成人I型糖尿病患病率与儿童I型糖尿病患病率对比（10）。然而，如果只考虑20岁之前被诊断的患者，这些数字是相关的。同样，我们的结果与其他地方的研究结果一致（1,2）。与我们的结果相反，Laakso和Pyorala（11）报道al-
Accurate data on the prevalence of type I diabetes in adults are scarce (1,2). It is often difficult to identify insulin-treated diabetic patients as either type I or type II based only on clinical grounds, especially when patients have been on insulin therapy for a long time. As recently stressed, there is a continual need for accurate information on the prevalence of type I diabetes in adulthood (2). We determined the prevalence of type I diabetes and the clinical characteristics of type I and type II insulin-treated patients in the Negev region of Israel. All known diabetic patients (insulin and non-insulin-treated) ^30 years of age from three community clinics of the Kupat Holim Sick Fund (which covers ~85% of the population) in Beer Sheva, the capital of the Negev, were studied. Insulin-treated patients were classified as either type I or type II patients according to fasting plasma C-peptide levels (3,4). Data were obtained from personal interviews, patients' medical records, physical examination, and laboratory analysis. Blood chemistries were performed by an automated method (SMA). Plasma C-peptide levels were determined in all patients. Results <0.132 nmol/1 were considered negative and >0.265 nmol/1 positive for endogenous insulin secretion (6,7). In case of a nondiagnostic result (C-peptide between 0.132 and 0.265 nmol/1), a glucagon test (8,9) was performed; a flat response was regarded as negative endogenous insulin secretion. Data obtained from questionnaires, physical examination, and the laboratory from each subject were coded and stored. Differences between means were computed using the Student's t test. Prevalence of comorbid conditions and diabetic complications were age-adjusted, using the combined population of type I and type II insulin-treated patients as the standard. The study target population comprised 9,573 adults >30 years of age; 588 subjects (6.1% of the study population) were diabetic; 100 patients (1.0% of the study population) were insulin-treated; 96 patients (36 men, 60 women) consented to enter the study. Seventeen percent of all known diabetic patients (100 of 588) were insulin-treated. Only 25% (24 of 96) of all insulin-treated patients had insulinopenic type I diabetes (by low Cpeptide levels). Thus, the prevalence of type I diabetes in adults in the Negev area of Israel was 2.5:1,000 (24 of 9,573). Table 1 contains data regarding age, age at diagnosis of diabetes, first treatment at diagnosis of diabetes, blood laboratory parameters, diabetes complications, and comorbidity (such as hypertension, hyperlipidemia, coronary artery disease, retinopathy, and albuminuria) in the type I and type II insulin-treated patients. This is the first time, to the best of our knowledge, that a comprehensive study on the prevalence of type I diabetes in adulthood, based on determination of fasting plasma C-peptide levels, has been done in Israel. The prevalence of type I diabetes in adults contrasts with that estimated for children in Israel (10). However, the figures correlate if only the patients diagnosed before age 20 are considered. Similarly, our results agree with studies performed elsewhere (1,2). Contrasting with our results, Laakso and Pyorala (11) reported that al-