| ObjectiveComparing the effectiveness of continuous subcutaneous injection（CSII）of insulin pump and continuous intravenous insulin infusion（CVII）in the treatment of children with diabetic ketoacidosis and the occurrence of hypoglycemia,to find a more optimized treatment;and investigating and analyzing the etiology of diabetic ketoacidosis（DKA）in children with type 1 diabetes mellitus（T1DM）.Methods1.Retrospectively analyzed the clinical data of 130 children with DKA who were treated from September 2018 to September 2020,the average age is（7.45±4.02）years old,and were divided into two groups according to their treatment methods:insulin pump continuous subcutaneous injection group（CSII group）and insulin intravenous infusion group（CVⅡgroup）,and the two groups were monitored and compared in terms of insulin dosage,duration of ketosis correction,number of hypoglycemic episodes,number of hospitalization days,and cost during hospitalization for the correction of ketoacidosis,and anion gap（AG）and carbon dioxide binding（CO2-CP）changes before and after treatment.2.The 130 DKA patients in the previous study were followed up through telephone interviews.At the same time,the clinical data of children with T1DM admitted to the same period were followed up in the same way.The clinical data of 69 children were collected,with an average age of（6.83±3.31）years old,grouped according to the presence or absence of DKA,and analyzed the relationship between the occurrence of DKA and related factors such as gender,age of onset,maternal weight gain during pregnancy,lifestyle habits,history of prodromic infection,and presence or absence of missed diagnosis and misdiagnosis.Results1.In the study comparing different treatment methods,the total insulin dosage,blood glucose reaching standard time,urine ketone negative conversion time,and blood gas analysis return to normal time in the CSII group were lower than those in the CVII group,and the difference was statistically significant（t=-2.16,-3.40,-3.79,-2.58,P<0.05）.The number（incidence）of hypoglycemia in the CSII group was lower than that in the CVⅡgroup（c2=3.900,P<0.05）.Comparing before and after treatment,AG was lower than baseline in both groups,and CO2-CP was higher than baseline in both groups,with statistically significant differences（t=8.48,8.27,-16.36,-16.88,P<0.01）.2.In the investigation and study of the cause of DKA,in the DKA group,the number of patients whose maternal weight gain≥16 kg during pregnancy,the number of patients with pre-infection,the number of missed and misdiagnosed patients were greater than those in the non-DKA group（61.76%versus 25.71%,82.35%versus 22.86%,52.94%versus 2.86%,P<0.05）,Logistic regression indicated that the occurrence of DKA is only related to progenitor infection,missed diagnosis,and misdiagnosis,that is,patients with progenitor infection have a higher risk of DKA than those without misdiagnosis or missed diagnosis（OR=0.136,P=0.003）,the risk of DKA in patients with misdiagnosis or missed diagnosis is higher than that of patients without misdiagnosis or missed diagnosis（OR=0.084,P=0.028）.Gender,ethnicity,age of onset,type of medical insurance,usual residence,education level of parents,history of diabetes during pregnancy,family history,whether family structure is stable,family income,feeding method after birth,age of supplementary feeding,usual dietary structure,whether there has bad eating habits,whether the exercise reached the standard,and the daily sleep time,with no statistically significant differences.（P>0.05）.Conclusion1.Compared with the traditional insulin therapy via intravenous,the insulin pump has a positive effect in the treatment of children with diabetes and ketoacidosis,and the incidence of hypoglycemia is lower.2.The occurrence of DKA is related to the excessive gain during pregnancy.3.The combination of pre-infection,missed diagnosis and misdiagnosis may be related to the occurrence of DKA,and can be used as an independent risk factor affecting the occurrence of DKA. |
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