CAJ | 학술논문

目的调查广东省1型糖尿病患者糖尿病酮症酸中毒(DKA)的发病率及其危险因素.方法 2010年8月6日至2012年3月31日在广东省16家医院收集1型糖尿病患者的人口学资料、病史等信息,中心化检测糖化血红蛋白(HbA1c)和固定餐后2hC肽等；DKA发病和复发的危险因素分别采用Poisson回归模型和Logistic回归模型分析.结果共纳入61 1例1型糖尿病患者,DKA发病率为26.4次/100人年,发病危险因素有女性(RR=2.12)、医保报销比例＜50％ (RR=1.84)、未控制饮食(RR=1.76)、吸烟(RR=2.18)和血糖控制差(RR=1.15).34.4％的DKA集中发生在3.8％有复发史的患者,复发的危险因素有女性(RR=10.56)、吸烟(RR =6.99)、胰岛功能差(RR =4.22)和血糖控制差(RR=1.16).结论广东省1型糖尿病患者DKA发病率高,且易复发；与一些可纠正的危险因素相关.
목적 조사광동성1형당뇨병환자당뇨병동증산중독(DKA)적발병솔급기위험인소.방법 2010년8월6일지2012년3월31일재광동성16가의원수집1형당뇨병환자적인구학자료、병사등신식,중심화검측당화혈홍단백(HbA1c)화고정찬후2hC태등；DKA발병화복발적위험인소분별채용Poisson회귀모형화Logistic회귀모형분석.결과 공납입61 1례1형당뇨병환자,DKA발병솔위26.4차/100인년,발병위험인소유녀성(RR=2.12)、의보보소비례＜50％ (RR=1.84)、미공제음식(RR=1.76)、흡연(RR=2.18)화혈당공제차(RR=1.15).34.4％적DKA집중발생재3.8％유복발사적환자,복발적위험인소유녀성(RR=10.56)、흡연(RR =6.99)、이도공능차(RR =4.22)화혈당공제차(RR=1.16).결론 광동성1형당뇨병환자DKA발병솔고,차역복발；여일사가규정적위험인소상관.
Objective To determine the incidence and the predictors of diabetes ketoacidosis (DKA) in Chinese type 1 diabetics so as to lay a foundation for better prevention and treatment.Methods For this cross-sectional study,a total of 611 patients with established type 1 diabetes between August 6,2010 and March 31,2012 were recruited from 16 hospitals in Guangdong Province.And 491 of them were over 18 years old.A data entry form was used to collect the patient information on demographics,medical history,acute/chronic complications,smoking/drinking status,diet,exercise,physical examination and treatment,etc.Hemoglobin A1c (HbA1c) and stimulated C peptide levels were centrally measured.The incidence rate of diabetic ketoacidosis (DKA) was calculated at events per 100 patient-years.To determine the predictors of DKA,Poisson's regression model was used for analysis.And backward stepwise logistic regression analysis was performed to identify the predictors of DKA recurrence.The protocol and informed consent form were approved by Ethics Committee of Third Affiliated Hospital,Sun Yat-sen University.Written informed consent was obtained from patients (age ＞ 18 years) or their legal guardians (age ＜ 18 years).Results Among them,53.7％ were females.The mean age was 27.8 years (range:19.5-37.3).The age of onset was 22.7 (14.0-31.4) years old and disease duration 4.3 (1.7-7.9) years.Overweight and obese patients accounted for 10.8％ and 1.0％ respectively.Among them,the selfmonitoring frequency of blood glucose was 0.4 (0.1-1.4) times per day.Overall,26.4％ patients reached the target of age-specific HbA1c values.The overall incidence of DKA was 26.4 per 100 patient-years.Significant predictors of DKA in the Poisson regression model were females (RR =2.12),medical insurance claiming percentage below 50％ (RR =1.84),uncontrolled diet (never controlled diet vs.usually controlled diet,RR =1.76),smoking (RR =2.18) as well as worse glycemic control (HbA1c per 1.0％ increment,RR =1.15).Totally,34.4％ of DKA episodes occurred in 3.8％ of type 1 diabetics with recurrent events (no less than 2 episodes).The recurrence of DKA was associated with females (RR =10.56),smoking (RR =6.99),worse beta cell function (stimulated C peptide per 100 pmol/L decrement,RR =4.88) and worse glycemic control (HbA1c per 1.0％ increment,RR =1.16).Conclusion There is a high incidence of DKA in Chinese type 1 diabetics.And it is recurrent in high-risk patients.Comprehensive management should be offered to control modifiable risk factors in these patients.