Metabolic control and prevalence of microvascular complications in young Danish patients with Type 1 diabetes mellitus
Metabolic control and prevalence of microvascular complications in young Danish patients with Type 1 diabetes mellitus
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DOI：
10.1046/j.1464-5491.1999.00024.x
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发表时间：
1999-01-01
影响因子：
3.5
通讯作者：
Mortensen, HB
中科院分区：
文献类型：
--
作者：
Olsen, BS;Johannesen, J;Mortensen, HB
目标。在丹麦全国范围内的调查（1987年，1989年）表明，不可接受的育雏血糖控制在年轻的糖尿病患者，我们开始估计目前的血糖控制和微血管并发症的患病率在一个队列中的儿童和青少年参与了前两个研究。该随访代表了339例患者（占初始队列的47%），中位年龄21.1岁（范围12.0-26.9），中位糖尿病病程13.2年（范围8.9-24.5）。进行标准化问卷调查、眼底照片（中央阅读）和体格检查。对HbA（1C）和夜间白蛋白排泄率（AER）进行集中分析。尽管88%（n = 309）的年轻人接受了每日三次或更多次胰岛素注射治疗，但HbA（1C）（非糖尿病范围4.3-5.8，平均5.3%）为9.7 +/- 1.7%（平均值+/- SD）。男性HbA（1C）值高于女性（P < 0.015）。平均每日胰岛素剂量为0.92 +/- 0.25 IU.kg（-1. 24 h（-1）。微量白蛋白尿（AER > 20-150 μ g/min）和大量白蛋白尿（AER > 150 μ g/min）分别见于9.0%和3.7%的患者，并与舒张压升高（P < 0.01）和视网膜病变（P < 0.01）相关。视网膜病变发生率约为60%，与年龄、病程、糖化血红蛋白（1C）、舒张压、AER有关（P均< 0.01）。亚临床神经病变（振动感觉阈值> 6.5 V）发生率为62%，与年龄、身高、舒张压（P < 0.01）和糖尿病视网膜病变（P = 0.01）显著相关。尽管大多数患者接受多次胰岛素注射，但只有11%的患者HbA（1C）值低于8%，肾脏、眼睛和神经的糖尿病微血管并发症的患病率高得不可接受。
Aims. After Danish nationwide investigations (1987, 1989) demonstrated unacceptable brood glucose control in unselected young diabetic patients, we set out to estimate the present glycaemic control and the prevalence of microvascular complications in a cohort of children and adolescents participating in the two previous studies.Methods. This follow-up represents 339 patients (47% of the inception cohort), median age 21.1 years (range 12.0-26.9), median diabetes duration 13.2 years (range 8.9-24.5). A standardized questionnaire, fundus photographs (with central reading) and a physical examination were performed. HbA(1C) and overnight albumin excretion rate (AER) were analysed centrally.Results. Although 88% (n = 309) of the young persons were treated with three or more daily insulin injections, HbA(1C) (nondiabetic range 4.3-5.8, mean 5.3%) was 9.7 +/- 1.7% (mean +/- SD). Males had higher HbA(1C) values than females (P < 0.015). Mean daily insulin dose was 0.92 +/- 0.25 IU.kg(-1).24h(-1). Microalbuminuria (AER > 20-150 mu g/min) and macroalbuminuria (AER > 150 mu g/min) were found in 9.0% and 3.7% of the patients, respectively, and was associated with increased diastolic blood pressure (P < 0.01) and presence of retinopathy (P < 0.01). Retinopathy was present in approximate to 60% of the patients and was associated with age, diabetes duration, HbA(1C), diastolic blood pressure and AER (all P < 0.01). Subclinical neuropathy (vibration perception threshold by biothesiometry > 6.5 V) was found in 62% and showed a significant association with age, linear height, diastolic blood pressure (all P < 0.01) and diabetic retinopathy (P = 0.01).Conclusions. In spite of the majority of the patients being on multiple insulin injections, only 11% had HbA(1C) values below 8% and the prevalence of diabetic microvascular complications in kidneys, eyes and nerves was unacceptable high.