Diabetes Care. 2001 Feb;24(2):239-44. doi: 10.2337/diacare.24.2.239.
To evaluate differences in HbA1c concentrations between centers and to assess the factors associated with glycemic control in young people with type 1 diabetes in Scotland.
Data on 1,755 patients (94% of those registered) were collected from 18 centers providing care to children <15 years of age. At every clinic visit, a duplicate HbA1c sample was measured in a reference laboratory, and clinical information was collected prospectively.
Average HbA1c concentration was 9.1% (range 5.0-15.0). The following significant associations with HbA1c level were identified: age, insulin regimen, BMI, season, social circumstances, and family history. HbA1c concentrations were significantly worse in older children (age 10-15 years 9.5% vs. other ages 8.8%, P < 0.001), those using two injections per day (2/day 9.1% vs. 3/day 8.8%, P < 0.01), children without both parents at home (9.4 vs. 9.0%, P < 0.001), a sibling with diabetes (9.7% vs. no family history 9.1%, P < 0.001). HbA1c concentration ranged from 8.1 to 10.2% between centers, after adjustment for factors associated with poor HbA1c (P < 0.001).
The overall glycemic control of diabetic young people in Scotland is equivalent to a Diabetes Control and Complications Trial HbA1c concentration of 8.7%, placing the majority at a high risk of the complications of diabetes in adulthood. Although factors were significantly associated with poor HbA1c adjustment for these did not explain the differences between centers. We suggest that factors not analyzed in DIABAUD2 (e.g., deployment of resources, organization of the clinical structure, strategies of care, and clinic philosophy) are the determinants of HbA1c. We speculate that the style of utilization of optimum resources is the key to achieving good glycemic control.
评估苏格兰各中心之间糖化血红蛋白（HbA1c）浓度的差异，并评估与1型糖尿病青少年血糖控制相关的因素。
从为15岁以下儿童提供护理的18个中心收集了1755例患者的数据（占登记患者的94%）。每次门诊就诊时，在参考实验室测量两份HbA1c样本，并前瞻性收集临床信息。
平均HbA1c浓度为9.1%（范围5.0 - 15.0）。确定了以下与HbA1c水平的显著关联：年龄、胰岛素治疗方案、体重指数（BMI）、季节、社会环境和家族史。年龄较大的儿童（10 - 15岁，HbA1c浓度为9.5%，其他年龄为8.8%，P < 0.001）、每天注射两次胰岛素的儿童（2次/天，HbA1c浓度为9.1%，3次/天为8.8%，P < 0.01）、父母不全在家的儿童（HbA1c浓度为9.4%，父母双全在家的为9.0%，P < 0.001）、有糖尿病兄弟姐妹的儿童（HbA1c浓度为9.7%，无家族病史的为9.1%，P < 0.001）的HbA1c浓度明显更高。在对与HbA1c控制不佳相关的因素进行调整后，各中心之间的HbA1c浓度范围为8.1%至10.2%（P < 0.001）。
苏格兰糖尿病青少年的总体血糖控制相当于糖尿病控制与并发症试验中HbA1c浓度为8.7%的情况，这使得大多数人成年后患糖尿病并发症的风险很高。虽然某些因素与HbA1c控制不佳显著相关，但对这些因素进行调整并不能解释各中心之间的差异。我们认为，DIABAUD2中未分析的因素（如资源配置、临床结构组织、护理策略和诊所理念）是HbA1c的决定因素。我们推测，优化资源的利用方式是实现良好血糖控制的关键。
