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目的应用动态血糖监测系统(CGMS)观察1型糖尿病患儿血糖控制情况,寻找评价和改善血糖控制的方法。方法收集复旦大学附属儿科医院2003年10月至2004年6月内分泌科门诊随访的儿童1型糖尿病患者28例,男16例,女12例,年龄(13.1±4.5)岁,病程(5.5±3.4)年,其中21例采用每天多次胰岛素注射(MDI),另7例使用胰岛素泵连续胰岛素输注(CSII)治疗。动态监测血糖3d,同时指尖血糖监测≥4次/d。结果(1)研究对象体重指数(BMI)为(19.4±3.0)kg/m2,糖化血红蛋白(HbA1c)为(8.4±1.6)%。CSII组HbA1c(8.2±1.0)%,MDI组HbA1c(8.5±1.8)%,差异有显著性意义(P<0.05);(2)CGMS发现22例77次餐后2h高血糖,CSII组4例(57.1%),每例出现1次,MDI组18例(85.7%),每例出现(4.1±2.5)次,差异显著(P<0.01);(3)CGMS发现17例79次低血糖,持续时间(76.6±92.8)min,而指尖血糖监测仅发现19次低血糖;白天低血糖持续时间(41.5±39.1)min,夜间(112.4±117.1)min,夜间低血糖持续时间显著长于白天(P<0.01)。(4)HbA1c≤8%组餐后高血糖发生率低于HbA1c>8%组(P<0.05),而低血糖的发生率显著升高(P<0.01)。结论1型糖尿病患儿多数存在低血糖和餐后高血糖;动态血糖监测系统是发现血糖异常波动的有效工具。动态血糖监测对指导1型糖尿病治疗,调整胰岛素剂量,从而改善血糖控制有着重要的临床意义。
Objective To observe the glycemic control in children with type 1 diabetes by dynamic blood glucose monitoring system (CGMS) and find ways to evaluate and improve glycemic control. Methods A total of 28 children with type 1 diabetes were enrolled in this study. They were 16 males and 12 females, aged (13.1 ± 4.5) years old with a duration of (5.5 ± 3.4) years ) Years, of which 21 cases received multiple daily injections of insulin (MDI), and the other 7 cases were treated with insulin pump continuous insulin infusion (CSII). Dynamic monitoring of blood glucose 3d, while fingertip blood glucose monitoring ≥ 4 times / d. Results (1) Body mass index (BMI) was (19.4 ± 3.0) kg / m2 and HbA1c was (8.4 ± 1.6)%. CSII group HbA1c (8.2 ± 1.0)%, MDI group HbA1c (8.5 ± 1.8)%, the difference was statistically significant (P <0.05); (2) CGMS 22 weeks after 2,7 postprandial hyperglycemia in 77 patients, (57.1%) in each case, once in each case and in 18 cases (85.7%) in MDI group (4.1 ± 2.5) in each case, the difference was significant (P <0.01) (76.6 ± 92.8) min, while only 19 hypoglycemia were detected in fingertip blood glucose monitoring. The duration of hypoglycemia during daytime was (41.5 ± 39.1) min, nighttime (112.4 ± 117.1) min, nighttime hypoglycemia was significantly longer than that of daytime P <0.01). (4) The incidence of postprandial hyperglycemia in HbA1c≤8% group was lower than that in HbA1c> 8% (P <0.05), while the incidence of hypoglycemia was significantly higher (P <0.01). Conclusions Most children with type 1 diabetes have hypoglycemia and postprandial hyperglycemia; the dynamic glucose monitoring system is an effective tool to find abnormal fluctuations of blood glucose. Dynamic glucose monitoring plays an important clinical role in guiding the treatment of type 1 diabetes, adjusting insulin dosage and improving blood glucose control.