The impact of a decade of changing of severe hypoglycemia in a population-based cohort of children with type 1 diabetes
The impact of a decade of changing of severe hypoglycemia in a population-based cohort of children with type 1 diabetes
复制标题
DOI：
10.2337/diacare.27.10.2293
复制
发表时间：
2004-10-01
期刊：
影响因子：
16.2
通讯作者：
Jones, TW
中科院分区：
文献类型：
--
作者：
Bulsara, MK;Davis, EA;Jones, TW
研究设计和方法-该队列由1,335名儿童组成（年龄9.5 ± 4.3岁[平均值+/- SD]，范围0-18），获得6,928患者年的数据。平均随访期为4.7 ± 3.1年（范围0-10.7）。在1992年至2002年期间对严重低血糖（导致意识丧失或癫痫发作的事件）及其相关临床因素和结局进行了前瞻性评估。每3个月对患者进行一次复查。使用负二项回归模型对数据进行分析。结果-共记录了944例严重事件。前5年，重度低血糖的发生率以每年29%的速度显著增加，但在过去5年中似乎趋于平稳。在整个随访期间，总体平均HbA（1c）显著下降（每年0.2%）。重度低血糖风险增加与HbA 1c较低、年龄较小、胰岛素剂量较高、男性和父母社会经济地位较低相关。在胰岛素治疗中，只有胰岛素泵治疗与严重低血糖发生率降低相关。结论-严重低血糖仍然是1型糖尿病儿童和青少年的主要问题。最近的治疗方法可能会在一定程度上改善控制，而不会增加预期的严重低血糖风险，但进一步监测将是重要的。
OBJECTIVE - To determine the impact of changes to treatment on the incidence of severe hypoglycemia and its risk factors in a large population-based cohort of children with type 1 diabetes.RESEARCH DESIGN AND METHODS - The cohort consisted of 1,335 children (age at entry 9.5 +/- 4.3 years [mean +/- SD], range 0-18), yielding 6,928 patient-years of data . The mean follow-up period was 4.7 +/- 3.1 years (range 0-10.7). Prospective assessment of severe hypoglycemia (an event leading to loss of consciousness or seizure) and associated clinical factors and outcomes was made between 1992 and 2002. Patients were reviewed every 3 months. Data were analyzed using the negative binomial regression model.RESULTS - A total of 944 severe events were recorded. The incidence of severe hypoglycemia increased significantly by 29% per year for the first 5 years but appeared to plateau over the last 5 years. The overall average HbA(1c) significantly decreased (by 0.2% per year) over the whole Follow-up period. An increased risk of severe hypoglycemia was associated with lower HbA(1c), younger age, higher insulin dose, male sex, and lower parental socioeconomic status. Of insulin therapies, only pump treatment was associated with reduced rates of severe hypoglycemia.CONCLUSIONS - Severe hypoglycemia remains a major problem for children and adolescents with type 1 diabetes. Recent approaches to therapy may be allowing a degree of improved control without the expected increased risk of severe hypoglycemia but further monitoring will be important.