MANAGEMENT OF DIABETES-MELLITUS IN CHILDREN YOUNGER THAN 5 YEARS OF AGE
MANAGEMENT OF DIABETES-MELLITUS IN CHILDREN YOUNGER THAN 5 YEARS OF AGE
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DOI：
10.1001/archpedi.1985.02140070022019
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发表时间：
1985-01-01
影响因子：
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通讯作者：
HUMMER, KM
中科院分区：
文献类型：
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作者：
GOLDEN, MP;RUSSELL, BP;HUMMER, KM
5岁以下胰岛素依赖型糖尿病儿童的最佳治疗方法尚未明确。患有这种疾病的幼儿（19）接受了一项计划的治疗，其中频繁的家庭血糖监测被用作教育计划的基础，强调父母根据当前的血糖水平和预期的饮食和锻炼来调整胰岛素。儿童（11名）在确诊后接受了治疗（I组），另外8名（D组）在不太密集的治疗后转诊。组I儿童的平均观察持续时间为13.6个月。（范围，6-24个月）。对于D组，诊断和转诊之间的平均时间为14.9个月。（范围，7-24个月）14.6个月（范围6-24个月）转介后。转诊前，D组有11例住院。强化治疗期间，D组有2例住院，I组有1例住院。每名儿童每18个月有3.3次严重低血糖发作。D组转诊前、转诊后分别为1.7次、0.4次。强化治疗期间14例严重低血糖发作中有10例发生在没有或很少进行家庭血糖监测的情况下。只有4次事件似乎是不可预测和不可预防的。与胰岛素依赖型糖尿病的持续时间和开始强化治疗的时间相比，D组患者的平均糖化血红蛋白水平较高。在诊断后，I组患者的平均每日胰岛素剂量逐渐增加，并且在15和18个月时与D组患者的平均每日胰岛素剂量相当。患病时间。因此，可以减少幼儿的住院和严重低血糖的频率。需要经常进行家庭血糖监测，并需要广泛的教育和心理社会支持，以使家庭实施这种强化方法。对心理神经发育的长期影响需要评估。
Optimal treatment for children younger than 5 yr of age with insulin-dependent diabetes mellitus is not well defined. Young children (19) with this disease were treated with a program in which frequent home blood-glucose monitoring was used as the basis for an educational program emphasizing parental adjustment of insulin in response to current glucose levels and anticipated diet and exercise. Children (11) were treated from diagnosis (group I) and another 8 (group D) were referred after less intensive treatment. The mean duration of observation of group I children was 13.6 mo. (range, 6-24 mo.). For group D, the mean time between diagnosis and referral was 14.9 mo. (range, 7-24 mo.) and 14.6 mo. (range 6-24 mo.) after referral. Before referral, there were 11 hospitalizations in group D. During the intensified program there were 2 hospitalizations in group D and 1 in group I. There were 3.3 episodes of severe hypoglycemia per child per 18 mo. in group D before referral, 1.7 episodes after referral, and 0.4 episodes in group I. Ten of 14 severe hypoglycemic episodes during intensified treatment occurred when there was no or infrequent home blood-glucose monitoring. Only 4 episodes seemed to have been unpredictable and unpreventable. Mean glycosylated Hb levels were higher in group D patients when compared with both the duration of insulin-dependent diabetes mellitus and the time of initiation of intensified treatment. Mean daily insulin doses increased progressively in group I patients following diagnosis, and were comparable with those in group D patients at 15 and 18 mo. duration of illness. Thus, frequency of hospitalization and severe hypoglycemia can be decreased in young children. Frequent home blood-glucose monitoring is required and extensive educational and psychosocial support is necessary for families to implement this intensive approach. The long-term effects on psychoneurological development need evaluation.