Glikemijska kontrola i prevalencija hipoglikemija kod dece i adolescenata sa dijabetesom melitusom tipa 1 lečenih insulinskim analozima

Ljiljana Plavšić; Katarina Mitrović; Sladjana Todorović; Rade Vuković; Tatjana Milenković; Dragan Zdravković

doi:10.2298/3802

Ljiljana Plavšić Mother and Child Health Care Institute of Serbia “Dr Vukan Čupić”, Belgrade, Serbia
Katarina Mitrović Mother and Child Health Care Institute of Serbia “Dr Vukan Čupić”, Belgrade, Serbia
Sladjana Todorović Mother and Child Health Care Institute of Serbia “Dr Vukan Čupić”, Belgrade, Serbia
Rade Vuković Mother and Child Health Care Institute of Serbia “Dr Vukan Čupić”, Belgrade, Serbia
Tatjana Milenković Mother and Child Health Care Institute of Serbia “Dr Vukan Čupić”, Belgrade, Serbia
Dragan Zdravković Mother and Child Health Care Institute of Serbia “Dr Vukan Čupić”, Belgrade, Serbia; Faculty of Medicine, University in Belgrade, Belgrade, Serbia

DOI: https://doi.org/10.2298/3802

Ključne reči: diabetes melitus, type 1||, ||dijabetes melitus, tip 1, child||, ||deca, adolescent||, ||adolescenti, hypoglycemia||, ||hipoglikemija, insulin||, ||insulin, treatment outcome||, ||lečenje, ishod,

Sažetak

Uvod/Cilj. Idealan insulinski režim za decu i adolescente sa dijabetesom melitusom tipa 1 (DMT1) trebalo bi da bude fiziološki, fleksibilan i predvidljiv, kao i da štiti od hipoglikemija. Cilj ove studije bio je procena uticaja insulinskih analoga na stepen glikemijske kontrole i učestalost hipoglikemijskih epizoda kod dece i adolescenata sa DMT1. Metode. Ciljna grupa obuhvatila je 151 dete i adolescenta (90 dečaka, 61 devojčica) koji su dobijali humane insuline bar 12 meseci pre uvođenja insulinskih analoga. Bolesnici su bili podeljeni u dve grupe: u prvoj je bilo 72 (47,7%) dece lečene sa tri injekcije regularnog humanog insulina pre obroka i dugodelujućim analogom insulina (RHI/DA), a u drugoj grupi 79 (52,3%) dece lečene kombinacijom brzodelujućeg i dugodelujućeg analoga insulina (BA/DA). Nivoi HbA1c i broj hipoglikemijskih epizoda registrovani su na početku terapije insulinskim analozima, i posle 6 i 12 meseci. Rezultati. Srednja vrednost glikoziranog hemoglobina (HbA1c) bila je značajno niža u prvoj grupi (RHI/DA) posle 6 meseci (9,15% vs 8,20%, p < 0,001) i posle 12 meseci (9,15% vs 8,13%, p < 0,001), kao i u drugoj grupi (BA/DA) posle 6 meseci (9,40% vs 8,24%, p < 0,001) i posle 12 meseci lečenja insulinskim analozima (9,40% vs 8,38%, p < 0,001). Učestalost teških hipoglikemija bila je značajno niža u obe grupe posle 6 meseci (u prvoj grupi sa 61,1% na 4,2% i u drugoj sa 54,4% na 1,3%, p < 0,001) i posle 12 meseci (u prvoj grupi sa 61,1% na 1,4% i u drugoj sa 54,4% na 1,3%, p < 0,001). Zaključak. Kod dece i adolescenata sa DMT1 lečenih insulinskim analozima utvrđen je značajno niži nivo HbA1c i manji rizik od teških hipoglikemija.

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