TCNCYH Phil trwang 80 (3) - 2012
K I E M S O A T GLUCOSE HUYET VA MOT S 6 Y i U T 6 NGUY CO O BENH NHAN DAI THAO OUdNG TYP 2 DlEU TRI NGOAI TRU TAI
BENH VIEN LAO KHOA TRUNG U-QNG
Tran Thj Thanh Huyin, Dd Thi Khanh Hy ' Trw&ng Dai hoc Dteac Hd NQI Chwcrng trinh kiSm soit b$nh nhin dii thio du^ng didu tri ngogi trO cd vai trd quan trpng ddi vdi kiSm soit glucose huy4t d$c biit & ngu^i cao tu6i. Nghiin cO'u nhim: (1) Nh0n xdt tinh hinh kiSm soit glue- cose huyit va mdt sd y4u t6 nguy ca 6 binh nhin dii thio typ 2 trin 60 tudi, (2) Nh$n xit mdt s6 ySu t6 liin quan dSn viic kiSm soit gluccose huyit d nhdm binh nhin nghiin cu-u trin. Di tii nghiin cCru trin 207 b$nh ntin tTi/pc chin doin dii thio dui^ng typ 2 diiu tri ngoai tru theo ddi liin fyc 3 thing tai binh viin Lie khoa Trung wang. Cic tiiu chuin dinh gii theo khuyin do cua Hdi Ndi tiit - DTD Viit Nam nim 2009. Kit qui cho ta thiy 66.7% b$nh nhin c6 HbAIC < 6,5%. 6.8% binh nhin cd HbA1C >7.5%, cholesterol vu thglycende & mOc dd tit chiim 58.6 % vi 26.4%. 21.2% bdnh nhan cd huyet ip tdt
< 130/80mmHg. MOc dd kiim soit gluccose huyit d nhOng b$nh nhin tuin thu chi dd diiu tij tdt han so vdi nhO-ng binh nhin khdng tuin thO chi dd diiu tn MOc dd kiim soit gluccose huyit khdng tdt tang din theo thCfi gian mic bdnh.
TCP khoa: dai thao dipdng, ki^m scat gluccose huydt, ngipdi cao tudi I . D A T V A N D e
Bai thai dudng la mpt trong nhOng benh khong ISy phat triin nhanh nhlit. Theo th6ng ke cua Lien doan dai thao du-dng qu6c t§, trdn the gidi tinh den nam 2010 hien co khoang 285 trieu ngu'di m^c benh dai thao du-dng chiem ty le 6,4% ngu'di tnjdng thanh va dy bao nam 2030 se co khoang 438 trieu ngu'di [6]. Tu6i thp cua benh nhan dai thao dudng tang cung lam cho bien chdng man tinh CO di^u kien xult hien va tang theo thdi gian bj benh. Quan ly benh nhan dai thao du-dng ngoai tru tot la di^u kien co th§ ngan Chan sy tiln triln cua cac bien chdng man tinh. Quan ly benh nhan dai thao du-dng co kiem seat bao g6m: kiem soat gluccose huyet (KSGH), HbAIC va cac ydu t6 nguy ca dgc biet la huylt ap va r6i loan lipid mau [5], 6 Viet Nam, da co nhiiu cong trinh danh gia hi$u qua cua viec quan ly benh nhan dai thao dydng ngoai tru nhu-ng chu-a co cong trinh nao danh gia d6i vdi benh nhan cao tuoi. D§
tai nay du-o-c thyc hien vdi muc tieu:
Nhan xet tinh hinh kiem soat gluccose huyet va mot so yeu td nguy ca a b$nh nhan dai thao duung typ 2 tren 60 tuoi dang diiu tri ngoai tru tai benh vien Lao khoa Trung LFang.
Nhan xet mot so yiu to Hen quan din viec kiem soat gluccose huyet a nhdm benh nhan nghien cCeu tren.
II. D O I TU'gNG VA PHLPaNG PHAP 1. 061 tu'O'ng nghien CIFU: benh nhan dai thao du-dng typ 2 tham gia chu-ong trinh quan ly dai thao du-dng ngoai tru.
-Dptudi >60
- Da du-g-c chan doan dai thao du-dng theo hu-dng d i n cua IDF 2005;
+ Du-dng huylt tu-ang luc doi s 7,0 mmol/l hoac nghiem phap tang du-dng huylt (+).
+ Va/hoac du-dng huylt tirang bit ky s 11,1mmol/l lam 2 lan.
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TCNCYH Phu tnmng 80 (3) - 2012
+ Va/hppc du-png huy^t tu'png mpt l^n bit ky £ 11,1mmpl/l khi bpnh nhSn c6 tripu chLrng l^r sang ro (HC 4 nhi^u).
- Dang dapc di4u tri vi theo doi dinh ky > 3 thang
- Kh6ng m l c kSm c4c b$nh: thilu m4u, b^nh noi tilt khSc, c6 biln chirng d p . 2. Phu'ang phap nghien ciru
2.1. Thiit ki ngl.iSn cuv: Ap dgng phppng phSp nghien CLTU md ta c l t ngang.
2.2. C& m l u va < ich chpn m l u : T i t ca b^nh nhSn dang d i l u trj ngcai trO dai thSp du'png typ 2 tei b^nh vi^n lap k ipa trung u'png tir th^ng 2/2011 d i n th^ng 8/2011.
2.3. Ky thu$t thu th$p thdng tin: Sir dgng phu'Png phSp phpng v l n (hoi b^nh), khSm ISm sSng vi xit nghiem c6ng thirc mau, sinh hda mau d l thu t h i p c i c th6ng tin theo cSc chi s4 nghi§n ciru. CSc ky thu^t xet nghiem du'pc thu'c hi^n khpa Hda sinh b^nh vi^n Lap khpa Thing U'png, X6t nghl#m gluccpse huylt map mach sau an 2 gicr sir dgng mSy Ascensia Elite cua hang Bayer.
2.4. Tidu chuin denh gii: thee khuyin cap ciia HOI Npi tilt - DTD Viet Nam nam 2009 Chi s6 Doin vj Tdt Chap nhan Kem Glucose huylt
- Luc doi mmol/l 4 . 4 - 6 . 1 < 7.0 > 7,0 - Sau an 4 , 4 - 8 . 0 s 10,0 > 10,0 HbAIC
Huylt ap BMI Cholesterol TP HDL-C Triglycerid LDL-C
%
mmHg kg/m2 mmol/l mmol/l mmol/l mmol/l
<6,5
< 130/80 18,5-22,9
<4,5
>1,1
<1,5
<2,5
6,5- 7,5 130/80-140/90
18.5-22.9 4 , 5 - 5,2
1 , 1 - 0 , 9 1,5- 2,2 2 , 5 - 3 . 4
>7,5
> 140/90 2 23
>5,2
<0,9
>2,2
>3,4 III. K £ T QUA
1. Tinh hinh k i l m soat glucose h u y l t va mpt sd y i u td nguy c v
Ting so 207 benh nhan du'pc di/a vao nghien ciru. Trong do bpnh nhan nhom tuli 60-69 chilm 49,8%, nhom t u l i 70 - 79 chilm 40,6% va nhom t u l i tren 80 chilm 9,7%. bpnh nhSn*
chilm 58.9% va nam chiem 41,1%. benh nhan co thpi gian mac benh < 5 nam chilm 44%, tCr5 -10 nam chilm 20,8%, va tren 10 nam la 35.2%. bpnh nhan co BMI binh thu'png chilm 48.1«, thira can va bee phi chilm 51,9%. Ty le benh nhan co tang huylt ap chilm 91.3%, vii cirii loan lipid mau chiem 84.1%.
Kilm seat HbAIC p mire dp tot va chip nhan co ty Ip cao 93,2%, mCrc dp kem ce ty 1$ tliif 6,8%. Kilm scat cholesterol toan phln va triglyceride a mire dp t i t thap chilm 58,6% w 26,4%. Kiem scat huylt ap mire dp t i t t h i p 21.2%.
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TCNCYH PhiJ truung 80 (3) - 2012 Bang 1. K i t qua kiem soat glucose h u y l t va mpt s i
Mu'C d$ k i l m spat D^c diem
DH lOo ddi
DH map m^ch sau an 2 gi&
HbAIC (%) Chclesterol toan phan Triglycerid LDL-C HDL-C HA
n i 111 42 138 102 46 99 47 40
Tct
%
53,6 20,3 66,7 58,6 26,4 56,9 27 21,2
y i u t l nguy C h i p nh$n n j 49 117
55 37 67 52 123 132
%
23,7 56,5 26,5 21,3 38,5 29,9 70,7 69,8
CP Kem n3 47 48 14 35 61 23 4 17
%
22,7 23,2 6,8 20,1 35,1 13,2 2,3 9 2. Mpt s6 yeu t l l i i n quan d i n k i l m spat glucose h u y l t
Tuli: So sanh cac miiic dp kilm seat glucose huylt & hai nhbm b^nh nhan tir 60 - 69 tuoi va nhom > 70 tuli khong thay sg' khac bi$t cd y nghla thing k§ vdi p > 0,05.
2.1. Tf 1$ b$nh nhan tuin thu chi dg dieu trj
Bang 2. Ty Ip b^nh nhan tuan thu cac che dp dieu tri
C h i do dieu trj C h i d | diing thuoc Chi dO an C h i dp tap luy$n Tuan thQ ( c i 3 c h i Sd)
S6 lirpng (n = Tuan thu
n i 200 169 134 130
%
96,6 81,6 64,7 62,8
= 207)
Khong tuan thd
n, % 7 3,4 38 18,4 73 35,3 77 37,2 C h i ad dieu trj: Co 200 bpnh nhan (96,6%) tuan thQ c h i dd diing thuoc, 169 bpnh nhan (81,6%) tuan thO c h i d * an, 134 b^nh nhan (64,7%) tuan thO c h i d * luySn tSp va 130 bpnh nhan (62,8%) tuSn thu day du c h i d$ dilu trj.
2.2. Liin quan giCea tuin thO diiu trj vdi kiim suit glucose huyit vi yeu td nguy ca K i t qua bang 3 chp t h i y gia trj gluccse huylt va HbAIC trung binh ciia nhu'ng bpnh nhan khong tuan thii c h i d$ dilu tr| cao hpn so vdi nhO'ng b^nh nhSn tuan thO d l y dO c h i d$ dilu trj. Sg' khac bi$t nay c6 i nghTa thing kS vpi p < 0,001.
2.3. Moi lidn quan gilhi thdi gian mac b$nh vdi kiim soit glucose huyit vi yiu td nguy ca Dai thap du'png typ 2 t i l n triln am thIm khong c6 tri$u chirng vi v§y chiing t l i coi thirl gian phat hi^n benh la thirl gian m l c b$nh.
K i t q u i blng 4 cho t h i y thdi gian m l c b$nh cang lau thi mire dp kilm spat glucose huylt kam cing tang. Sg' khac bi$t c6 ^ nghTa thong k l vdi (p < 0,01).
TCNCYH PhtJ truxyng 80 (3) - 2012
Bang 3. Lien quan giO'a tuan thu dilu trj vdi kilm spat glucose huylt va y i u td nguy co
Chisd DH liic doi (mn-o:/l)
DH mao mgch sau an 2 gip (mmol/l) HbA1C(%)
Tuan thii dilu trj (n, = 130) 5,90+1,07 8,78 ±1,23
Khdng tuan thu dilu trj (n; = 77) 7,30 + 2,07 10,66 ±2,4
< 0,001
< 0,001 5,84 ±0,7 6,67 ± 0,99 < 0,001 Cholesterol toan phln (mmol/l)
Triglycerld (mmorn LDL-C (mmol/l) HDL-C (mmol/l) HA tam thu (mmHg) HA tam tru'ong(mniHg) BMI (kg/m2) '
4,38 ±0,99 2,07±1,15 2,46 ± 0,78 1,09 ±0,24 127,08 ±10,45
78,27 ±6,377 22,88 ± 2,53
4,62 ±1,23 2,21 ±1,6
0.137 0,470 2,62 ± 0,9
1,07 ±0,14 129,12 ±12,86
79,68 ±6,71 0,134 23,25 ± 2,87 0,331 Bang 4. Lien quan kilm soat glucose huylt va yiu td nguy co' vdi thdi gian mlc b^nh
< 5 n a m 5 - < 10 nam > 10 nam Dac diem
n2
%
n jDH IOC doi Tot. chap nhan 80 87,9 30 69,8 50 68,5
Kem 11 12.1 30.2 - < 0.01
DH mao mach Tot, chip nhan
sau an 2 gip Kem 10
30 13
69,8
30,2 - < 0,001
HbA,C Tot, chap nhan 88 97,7
Kem 1 2.3 10 13,7 - < 0,01
IV. BAN LUAN
Tinh hinh kilm soat glucose huylt va mdt sd yiu td nguy co>
Nghien ciru che thiy nhom tuoi 60 - 69 co ty le cao nhat, ty Ip nCr cao hpn nam. Kit qua nay tu'png tg nhu- nghien cu'u cua cac tac gia p trong nu'dc [2. 3, 4] cung nhu- tren t h i gidi [8]. Thpi gian mac bpnh tren 10 nam chiem 35,2%. tu'png tp nghien ciru ciia Nguyin Minh Sang (34.6%)[4], de d l i tupng nghien CU'U la benh nhan dai thac dupng cao t u l i nen thdi gian bj m l c benh thudng lau ngay.
K i t qua nghipn ciru chp thiy chi s i HbAIC trong nghien ciru ciia chiing toi mire dp tot CO ty le cap nhlt 66,7%. mire dp kem
60
ce ty Ip t h i p nhlt 6,8%. Chi so HbAIC a mite dp t i t trong nghien ciru nay cao hon so vdi cac nghien ciru trcng nu'dc - ty le tuwng irng la 56,5% va 18,8% [3]; hay 12,5% va 80,8% [4] va ca vdi nghien ciru tai My tuong irng la 34%, va 18,8% [8]. Trong khi do kiem scat huylt ap d mire d | t i t chilm ty le thip 21.2% va t h i p hpn nghien ciru khac IS 40.0% va 66,2% [2, 3]. D i l u nay cd t h i la do doi tu'png nghien ciru nay da tham gia chu'png trinh quan ly dai thao du'dng nhilu nam va kham dinh ky hang thang ndn mire dp kilm spat HbAIC t i t cap hpn cac nghiSn ciru khac nhu'ng la ngu'di cac t u l i va thdi gian phat hipn bSnh nhieu nam nen kilm soat huylt ap khe khan hon.
TCNCYH Phu taeang 80 (3) - 2012 Kiem soat cholesterol toan ph^n d^t hieu
qua han, tiong khi kiem soat triglycerid con kem. Ket qua nay tu-ang t y nhu- nghien cu-u Pham Thj H6ng Hoa, Nguyin khoa Dieu Van [3, 5]. Dieu nay cung phu hg-p vdi tinh hinh chung cua benh nhan dai thao du-dng typ 2 Viet Nam la kho kilm soat thanh phln triglyc- erid. Co le do c h i dp an con nhilu chat bpt va nam gidi uong ru-p'u nhieu.
Mpt sd y i u td lien quan d i n k i l m soat gluccose huylt
Kit qua cho thay mdc dp kiem soat gluc- cose huylt. lien quan chgt che vdi thdi gian mac benh cua benh nhan. Mu-c dp soat gluc- cose huylt va HbAIC kem d nhom benh nhan dup-c phat hien dai thao du-dng tren 10 nam tang cao. Kit qua nay tu-ang tu- nhu- cac nghien cu-u trong nu'dc Nguyin Minh Sang, Ta Van Binh [1, 4]. Nguyen nhan la do ca c h i benh sinh cua dai thao du-dng typ 2, sau 10 nam t l bao P cua dao tuy khong con kha nang bai tilt insulin hoac bai tilt khong dang k l . Chinh vi vay, thdi gian mac benh cang lau thi khang insulin cang tang, hau qua la soat gluccose huylt kho khan. Ngoai ra, nhu-ng benh nhan co thdi gian mac benh lau thu'dng co nhilu biln chu-ng lam cho hp chan nan dan d i n khong tuan thu dilu tri. D i l u tri dai thao du'dng phai k i t hp'p c h i dp an, t^p luyen va dung thuoc la dieu trj n i n tang va phai duy tri ca ddi. Trong nghien cu-u nay ty le benh nhan tuan thu c h i dp dung thuoc la 96,6%, cao han viec tuan thu c h i dp dilu tn (chi d0 an, tap luyen, thulc) 62,8%. Kit qua nghien cdu cua chOng toi tu-ang ty nhu- cac nghien cdu khac [3, 4] cho thiy d nhom benh nhan khong tuan thu d l y du c h i do dieu tri thi nong dp gluccose huylt trung binh va HbAIC cao han so vdi nhom chip hanh dly dti.
Doi tu'O'ng nghien cu-u nay la nhung benh
nhan cao tuoi va thudng mac kem cac benh man tinh khac nen se anh hudng den viec thu-c hien c h i dp an va tap luyen Do do, chuang trinh quan ly benh nhan dai thao du-dng ngoai tru cung nen chu y tu van va dilu tri tich eye han cho hp. Ding thdi ngoai viec tu v l n cho benh nhan cac bac sy nen tu v l n cho ngu-di nha d l cung phoi hp'p thyc hien c h i dp dilu tri phu hap.
Qua phan tich k i t qua cho thiy khong co sy lien quan gida viec soat gluccose huylt vdi dung kem cac thuoc lam thay doi nong dp du'dng huylt (chen p giao cam, uc c h i men chuyin, chen kenh canxi, Ip-i tilu thiazid, uc che MAO, salicylat). Trong qua trinh nghien cdu chung toi thiy c6 mot vai benh nhan khi diing kem nhdng thuoc nay thi co anh hu'dng d i n du-dng huylt. Tuy nhien, nlng dp du-dng huylt d nhu-ng benh nhSn nay d l u du-p-c dieu chi'nh kip thdi do cac bac sy da bilt dup-c tac dung phu cua thulc dung kem va benh nhan thyc hien t i t viec kham lai dinh ky hang thang.
V. K^T LUAN
Tinh hinh kilm soat glucose huyet va mot s6 y i u td nguy c c
Kilm soat HbAIC da s i d mdc do tot (chilm 66,7%), mdc dp kem rlt thip (chilm 6,8%).
Kilm soat huylt ap mdc dp t i t con thip (21,2%).
Kilm soat cholesterol toan phln muc dp tot CO ty le cao nhat (58,6%), triglyceride myc dp t i t con thap (chilm 26,4%),
Mot sd y i u td lien quan d i n k i l m soat glucose h u y l t
Thdi gian mac benh dai thao du-dng va viec tuan thu c h i do dieu tri la y i u t l anh hudng doi vdi viec kilm soat dudng huylt.
TCNCYH Phu tnmng 80 (3) -2012 VI. K H U Y I N NGH!
Chu'png trinh quan ly bpnh nha dai thao du'dng ngoai trii tai bpnh vi$n Lap khoa Trung upng chu yeu la ngu'di cao tuli. Dilu nay anh hu'dng d i n v l n d l kilm scat glucose huylt cua benh nhan. VI vpy c i n tu' v l n cho benh nhan va ngu'di nha thgc hi6n d l y dii che dp dieu tr|, dpc bi^t la c h i dp dinh dudng va tap luy$n phai phii hpp vdi doi tu'png nay.
Can chu y kilm soat glucose huylt sau an va huyet ap t i t hpn. Ngoai ra doi vii\ nhCrng b$nh nhan mac benh lau ngay phai tang cudng tu van va giam sat c h i dO dilu tri.
TAI LIEU THAM KHAO 1. Ta Van Binh (2007). Thu'c trang dai thao dudng - suy giam dung nap glucose, cac yiu t l lien quan va tinh hinh quan ly benh d Ha Noi. Tap chi Y - Ducc hpc Quan sg. (4): 52 - 58.
2. Nguyen Thi Ngpc Han, Dang Bich Thuy, Vii Dinh Triln va cs (2010). Danh gia hieu qua kilm soat da y i u t l d benh nhan dai thao du'dng type 2 dilu tri tai Trung tam y t l dg phong Thai Binh Tap chi dinh du'dng va thuc phlm. 6 (1): 65 - 71
3. Pham Thj Hdng Hoa (2010). Nghien ciru kit qua kilm soat mpt s i chf s i lam
sang, can lam sang, biln chirng P bpnh nha dai thao du'dng typ 2 dapc quan ly dieu t ngopi trii, Luan an T i l n sy Y hpc, Hpc vie Quan Y.
4. Nguyin Minh Sang, Nguyin Khoa Dipi van, Nguyin Quang Bay (2007). Thgc trani kilm soat gluccose huylt d cSc b^nh nhan di thao dudng typ 2 nhap vipn dilu trj tai khoa Nc tilt, b#nh vi$n Bach Mai Tpp chi nghien ciru 1 hpc, Phu tarpng 63 (5): 1 7 - 2 3
5. Nguyin Khoa Dieu Van (2006). Dan) gia hieu qua ciia phupng phap dilu trj tic!
cgc d l han c h i cac y i u t l nguy co dli vo banh ly mach mau a bpnh nhan dai thac dgdng typ 2 mdi phat hien, Luan an Tiln s) Y hpc, Tru'dng Oai hpc Y Ha Npi.
6. International Diabetes Federation (2011). Annual report 2010. 20.
7. Meneilly G.S (2009) Pathophysiology of Diabetes In The Elderly. Diabetes in Old Age" Third Edition, John Wiley 8. Sons Ltd, Chichester, UK. 3 - 5 , 13.
8. Ozra T.M., Maryam P., Ramin H., etal (2011). Status of diabetes care in elderly dia- betic patients of a developing country, Iranian Journal of Diabetes and Lipid Disorders. 10:
1 - 8 Summary
GLYCEMIC CONTROL AND ITS RISK FACTORS OF OUTPATIENTS WITH TYPE 2 DIABE- TES IN THE NATIONAL HOSPITAL OF GERIATRIC
The program for management of outpatient patients with type 2 diabetes plays an important role in improving the glycemic control. The management for elderly patients, howiever, hasnl been assessed in recent years. Objective of the study (1) v»as to describe the situation of con- trolling glycemic and its risk factors of outpatients over 50 years with type 2 diabetes; and (2) To identify some factors influencing glycemic control in the National Hospital of Geriatric in2011.
The results showed that these data indicated that 66,7% patients had good glycemic control with HbAIC < 6.6%; only 6.8 % patients had poor glycemic control with HbAIC >7.5%. Addi- tionally, those who had cholesterol and triglyceride at good level were 58.6 % and 26.4%,5 spectiveiy. Only 21.2% patients had blood pressure < 130/80mmHg, however. Better glycemit
TCNCYH Phu truxyng 80 (3) - 2012 control level was observed in patients who complied strictly with the therapy regimen than those who didn't with significant difference (p < 0.001). The longer duration of disease was the worse glycemic control level (p < 0.05). In conclusion, almost elderiy outpatients had good and ac- ceptable glycemic control level. The cholesterol control was better than triglyceride control ob- served in these patients. Only a small number of patients had a good blood pressure control.
Related factors that influence glycemic control are the compliance of therapy regimen and dura- tion of suffering from the disease.
Key words: Diabetes, glycemic control, elderly
AP DUNG PHAC D 6 CHUYEN INSULIN TRUYEN TTNH MACH SANG DU'DNG TIEM DU'QI DA O CAC BENH NHAN
DAI THAO DU'DNG CO BIEN CHU'NG CAP TJNH
Nguyin Khoa Dieu Van, Trinh Nggc Anh Truing Dai hoc Y Ha Noi Cic phic dd chuyin insulin truyin tTnh mach sang tiem dudi da da du^c nghien c&u nhiiu trin thi gidi. Nghiin cuv nhim dinh gii hieu qua cOa phic do chuyin insulin truyin tTnh mach sang tiim dudi da trong kiim soit glucose miu 6 benh nhan dai thao duung cd biin chiing cip tinh va phan tich cac yiu td inh hi^ng tdi hiiu qui cua phic dd Kit qua cho thiy, hiiu qua kiim soil glucose mau sau chuyin tiim dirdi da: gli tri glucose miu trung binh sau chuyin tiem difdi da tir 12,12 - 12,38mmolA: muc dao ddng glucose miu li 3.57— 4,05 mmoiA, ty le glucose mau duac kiim soat theo muc tieu la 36 - 38%, ty le ha glucose miu li 0.83%. Cic yiu tdanh huung cic benh nhin HbAlc < 10.0% vi duv/c truyin insulin tinh mach liiu trung binh < 3.0 Ul/gid cd ty 1$ kiim soat glucose mau cao han nhdm binh nhin cd HbAlc >
10,0% vi truyin insulin ^3,0 Ul/gid. Kit luan phac dd chuyin insulin truyin tinh mach sang tiem dwdi da giOp kiim soit tdt va it gay ha glucose, die biet d nhdm benh nhin HbAlc £ 10.0% va duac truyin insu- lin < 3,0 Ul/gia.
TIP khoa: dai thao duvng, insulin truyin tinh mach, Insulin tiem du>di da
' I. BAT V A N D £ benh [3]. Tuy nhien khi cac benh nhan nay da Hien nay, dai thao du-dng da va dang trd on dinh tinh trang d p cdu, dilu tn chuyin 1 thanh mot v l n d l sdc khoe toan c l u vdi s i sang dung insulin theo dudng tiem du-di da lu'p'ng benh nhan ngay cang gia tang [1, 2]. la can thilt nham giam bdt chi phi, giam i Tang glucose mau va cac biln chung cap ganh nang d l i vdi nhan vien y t l , tao dilu 1 tinh la nhung ly do chinh khiln cho benh kien cho benh nhan du-gc xuat vien dilu tri I nhan dai thao du-dng phai nhap vipn. Cac ngoai tru [5], Tren t h i gidi hien da co nhilu
; nghidn cuu g i n day d l u chdng minh rang nghien cdu xoay quanh v l n d l chuyin I kiem soat glucose mau chat che blng truyin insulin truyin tTnh machsang du-dng tiem (insulin du-dng tTnh mach tren cac benh nhan dudi da nhung d Viet Nam cac nghien cuu unay da dem lai nhilu Ip-i ich d l i vdi ngu'di d l cap tdi khia canh nay con it. Do do, d l tai 63
