摘要
目的基于持续扫描式葡萄糖监测系统探讨二甲双胍联合胰岛素注射液治疗青春期1型糖尿病(T1DM)儿童的疗效。方法2018年1月至2023年5月门诊随访的青春期T1DM儿童99例,48例胰岛素联合盐酸二甲双胍片治疗为观察组,51例单用胰岛素治疗为对照组。比较两组儿童各项临床资料、监测指标及安全性。结果在3个月随访时观察组、对照组平均目标范围内时间(TIR)分别为76.6%±9.1%、65.9%±15.0%,中位高血糖时间(TAR)两组分别为7.0%(3.0%~14.3%)、21.0%(12.0%~29.0%),平均低血糖时间(TBR)两组分别为14.5%±7.1%、10.2%±6.8%,在6个月随访时观察组、对照组平均TIR两组分别为76.0%±8.9%、65.5%±14.3%,中位TAR两组分别为8.0%(3.3%~13.8%)、24.0%(15.0%~29.0%),平均TBR两组分别为14.4%±5.9%、10.0%±6.8%,以上变量两组间差异均有统计学意义(P均<0.05)。观察组两次随访中位胰岛素用量低于对照组。48例观察组患儿两次随访时中位胰岛素用量、中位BMI、平均TIR、平均TBR均高于其基线水平,中位TAR水平低于自身基线水平,以上变量差异均有统计学意义(P均<0.05)。观察组4例(8.33%)出现胃肠道症状,无严重低血糖发生。结论二甲双胍联合胰岛素治疗方案,可以有效提高青春期T1DM儿童TIR。TBR水平增加,并不增加严重低血糖风险,安全性良好。二甲双胍联合胰岛素治疗对青春期T1DM儿童是一种可行的选择。
Objective To investigate the efficacy of metformin combined with insulin injection in the treatment of adolescents with type 1 diabetes mellitus(T1DM)based on the continuous scanning glucose monitoring system.Methods A total of 99 adolescents with T 1 DM were followed from January 2018 to May 2023.The observation group,comprising 48 adolescents,received a combination of insulin and metformin,while the control group of 51 patients was treated with insulin alone.The clinical data,monitoring indices and safety profiles of both groups,were compared.Results At the 3-month follow-up,the mean time in the target glucose range(TIR)was significantly higher in the observation group at 76.6%±9.1%compared to 65.9%±15.0%in the control group.The median time above target glucose range(TAR)in the two groups was 7.0%(3.0%-14.3%)and 21.0%(12.0%-29.0%),respectively.The mean time below target glucose range(TBR)was 14.50%±7.13%in the observation group and 10.2%±6.8%in the control group.At the 6-month follow-up,the mean TIR in the observation group was 76.0%±8.9%compared to 65.5%±14.3%in the control group.The median TAR in the observation group was 8.0%(3.3%-13.8%),while in the control group it was 24.0%(15.0%-29.0%).The median TBR in the observation group was 14.4%±5.9%in contrast to 10.0%±6.8%in the control group.The differences in these variables between the two groups were statistically significant(all P<0.05).At the 3-month and 6-month follow-up,the median insulin dosage required by the observation group was lower than that of the control group(all P<0.05).At two follow-up visits,the median insulin dosage,median BMI,average TIR and average TBR of the patients in the observation group were all higher than their baseline level,and the median TAR level was lower than their baseline level,with statistical significance(all P<0.05).Gastrointestinal symptoms were reported in 4 cases(8.33%)of the observation group,with no severe hypoglycemia observed.Conclusions The combination of metformin with insulin therapy significantly improved TIR in adolescents with T 1 DM.Although TBR level increases,this treatment regimen does not increase the risk of severe hypoglycemia.Metformin demonstrated a favorable safety profile,suggesting that the insulinmetformin combination is a viable treatment option for adolescents with T 1 DM.
作者
刘芳
陈琼
李杨世玉
李园
曹冰燕
卫海燕
张淼
LIU Fang;CHEN Qiong;LI Yangshiyu;LI Yuan;CAO Bingyan;WEI Haiyan;ZHANG Miao(Department of Endocrinology and Inherited Metabolic,Children’s Hospital Affiliated to Zhengzhou University,Henan Children’s Hospital,Zhengzhou Children’s Hospital,Zhengzhou 450018,Henan,China;Department of Endocrinology,Genetics and Metabolism,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Pharmacy,Children’s Hospital Affiliated to Zhengzhou University,Henan Children’s Hospital,Zhengzhou Children’s Hospital,Zhengzhou 450018,Henan,China)
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2024年第9期774-781,共8页
Journal of Clinical Pediatrics
基金
2022年河南省科技攻关项目(No.222102310508)
2021年度河南省医学联合共建项目(No.LHGJ20210678)。
