diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM12431diaendo-12431Research ArticleОригинальные исследованияOriginal StudiesРетроспективное исследование применения аналогов инсулина продленного действия детемир и деглудек у детей и подростков для преодоления вариабельности гликемии, обусловленной феноменами «утренней и вечерней зари»Retrospective trial of long acting analogues detemir and degludec usage in children and adolescents to overcome glucose variability caused by dawn phenomenon and reverse dawn phenomenonhttps://orcid.org/0000-0001-5689-0194ВитебскаяА. В.VitebskayaA. V.

Витебская Алиса Витальевна, к.м.н.

119881, Москва, ул. Б. Пироговская, д. 19

eLibrary SPIN: 9857-9551 

Alisa V. Vitebskaya, MD, PhD

19 B. Pirogovskaya street, 119881 Moscow

eLibrary SPIN: 9857-9551 

dr.vitebskaya@gmail.comhttps://orcid.org/0000-0003-0031-1389ШрёдерЕ. В.ShrederE. V.

Шрёдер Екатерина Владимировна 

eLibrary SPIN: 7997-2501 

Москва

Ekaterina V. Shreder, MD

eLibrary SPIN: 7997-2501 

Moscow

evshreder@bk.ruhttps://orcid.org/0000-0002-9660-8795ПоповичА. В.PopovichA. V.

Попович Анастасия Владимировна 

eLibrary SPIN: 3241-4064 

Москва

Anastaiya V. Popovich, MD

eLibrary SPIN: 3241-4064 

Moscow

krutova_nastasya@mail.ruhttps://orcid.org/0000-0002-4184-2605ПисареваЕ. А.PisarevaE. A.

Писарева Елена Александровна, к.м.н. 

eLibrary SPIN: 7463-2105 

Москва

Elena A. Pisareva, MD, PhD

eLibrary SPIN: 7463-2105 

Moscow

pisarevaea@rambler.ruПервый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский университет)РоссияI.M.Sechenov First Moscow State Medical University (Sechenov University)Russian FederationПервый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский университет); ГБУ «Морозовская ДКБ ДЗМ»РоссияI.M.Sechenov First Moscow State Medical University (Sechenov University); Morozov Children’s Municipal Clinical HospitalRussian FederationПервый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian Federation202102082021244315324Copyright © Витебская А.В., Шрёдер Е.В., Попович А.В., Писарева Е.А., 20212021Витебская А.В., Шрёдер Е.В., Попович А.В., Писарева Е.А.Vitebskaya A.V., Shreder E.V., Popovich A.V., Pisareva E.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/12431Обоснование

Обоснование. Детям с сахарным диабетом 1 типа (СД1) требуется больше инсулина в поздние вечерние часы (­феномен «вечерней зари» (ФВЗ)), а подросткам — в ранние утренние часы (феномен «утренней зари» (ФУЗ)), что является причиной вариабельности гликемии. Современные аналоги инсулина пролонгированного действия позволяют добиваться удовлетворительного гликемического контроля.

Цель

Цель. Изучение особенностей инсулинотерапии у детей и подростков с СД1 с использованием аналогов инсулина детемир и деглудек для преодоления вариабельности гликемии, обусловленной ФУЗ и ФВЗ, в различные возрастные периоды.

Методы

Методы. Проанализированы медицинские карты 200 пациентов, госпитализированных в 2013–2019 гг., применявших детемир, средний возраст которых составил 9,0 года (5,4; 13,0), с СД1 средней длительностью 1,3 года (0,5; 3,0); а также медицинские карты 50 пациентов, переведенных на деглудек, в 2018–2019 гг. в среднем возрасте 12,0 года (10,5; 14,5) со средней длительностью СД1 3,0 года (1,5; 6,0). До перевода на деглудек пациенты были на интенсифицированной инсулинотерапии с применением гларгина (22), детемира (26) или на помповой инсулинотерапии (2); у 16 (32%) были клинические проявления ФУЗ, у 5 (10%) — ФВЗ.

Результаты

Результаты. У 67 из 108 (62%) детей в возрасте 1–9 лет было выявлено перераспределение доз детемира на дневное время; у 58 из 92 (63%) в возрасте 10–17 лет — на ночное. В группе пациентов, переведенных на деглудек, отмечено снижение уровня HbA1с с 8,7% (7,8; 9,9) до 8,0% (7,4; 9,0) (р<0,001); гликемии натощак с 9,8 ммоль/л (7,4; 11,7) до 7,7  ммоль/л (6,4; 8,6) (р<0,001); вариабельности гликемии в течение дня с 35,2% (31,6; 40,9) до 23,5% (19,7; 28,6) (р<0,001); суточной дозы инсулина с 0,98 Ед/кг/сут (0,82; 1,14) до 0,87 Ед/кг/сут (0,75; 1,07) (р=0,002). В подгруппах пациентов с ФУЗ и ФВЗ отмечено снижение гликемии натощак (с 11,5 ммоль/л (9,8; 13,8) до 7,5 ммоль/л (6,6; 9,1; р<0,001) и гликемии в поздние вечерние часы (с 11,0 ммоль/л (10,2; 11,2) до 8,0 ммоль/л (6,7; 9,5; р=0,03) соответственно. ­Достигнутые показатели гликемического контроля не различались между подгруппами пациентов, исходно использовавших детемир или гларгин.

Заключение

Заключение. Достижение компенсации углеводного обмена при СД1 может быть затруднено в связи с ФУЗ и ФВЗ. Перевод на деглудек обеспечивал улучшение гликемического контроля и уменьшение вариабельности гликемии, обусловленной ФУЗ и ФВЗ.

Backgraund

Backgraund: Children with type 1 diabetes mellitus (T1DM) need more insulin late in the evening (reverse dawn phenomenon (RDP)), and adolescents need more insulin yearly in the morning (dawn phenomenon (DP)); these cause blood glucose variability. Modern long acting insulin analogues allow to achieve satisfactory glycemic control.

Aims

Aims: To study the characteristics of insulin therapy in children and adolescents with T1DM using insulin analogues detemir and degludec to overcome blood glucose variability caused by DP and RDP in different age periods.

Materials and methods

Materials and methods: We analyzed medical documents of 200 patients using detemir, admitted to pediatric endocrinology department in 2013–2019, at mean age 9.0 years (5.4; 13.0), with T1DM for 1.3 years (0.5; 3.0); and medical documents of 50 patients switched to degludec in 2018–2019 at mean age 12.0 years (10.5; 14.5) with T1DM for 3.0 years (1.5; 6.0). Before degludec they were on intensive insulin therapy with glargine (22), detemir (26), or insulin pump (2); 16 patients (32%) presented with clinical characteristics of DP, and 5 (10%) — RDP.

Results

Results: 67 children of 108 (62%) aged 1–9 years had redistribution of detemir doses to daytime; 58 adolescents of 92 (63%) aged 10–17 лет — to nighttime. Patients switched to degludec demonstrated decrease in HbA1с from 8.7% (7.8; 9.9) to 8.0% (7.4; 9.0) (р<0.001); fasting blood glucose from 9.8 mmol/l (7.4; 11.7) to 7.7 mmol/l (6.4; 8.6) (р<0.001); within-day variability from 35.2% (31.6; 40.9) to 23.5% (19.7; 28.6) (р<0.001); daily insulin dose from 0.98 U/kg/day (0.82; 1.14) to 0.87 U/kg/day (0.75; 1.07) (р=0.002). Sub-groups of patients with DP and RDP demonstrated decrease in fasting blood glucose (from 11.5 mmol/l (9.8; 13.8) to 7.5 mmol/l (6.6; 9.1) (р<0.001)), and late evening blood glucose (from 11.0 mmol/l (10.2; 11.2) to 8.0 mmol/l (6.7; 9.5) (р= 0.03)) correspondently. Achieved levels of glycemic control did not differ between sub-groups of patients initially using glargine or detemir.

Conclusions

Conclusions: Compensation of T1DM may be complicated due to DP and RDP. Switching to degludec allowed to achieve better glycemic control and lowering of blood glucose variability caused by DP and DRP.

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The authors declare that there are no conflicts of interest present.