Craig Maria E, Handelsman Penny, Donaghue Kim C, Chan Albert, Blades Barbara, Laina Rosetta, Bradford Darna, Middlehurst Angela, Ambler Geoffrey, Verge Charles F, Crock Patricia, Moore Patrick, Silink Martin
Department of Paediatrics, St George Hospital, Gray Street, Kogarah, NSW 2217.
Med J Aust. 2002 Sep 2;177(5):235-8. doi: 10.5694/j.1326-5377.2002.tb04754.x.
To audit glycaemic control and incidence of severe hypoglycaemia in children and adolescents with type 1 diabetes in New South Wales (NSW) and the Australian Capital Territory (ACT).
A multicentre, population-based, cross-sectional study from 1 September to 31 December, 1999.
1190 children and adolescents aged 1.2-15.8 years with type 1 diabetes, identified from three hospital-based paediatric diabetes units, four private city-based paediatric practices and 18 regional outreach clinics in NSW and the ACT.
HbA(1c) level and incidence of severe hypoglycaemia (defined by unconsciousness or seizures).
The response rate was 67% (1190 of a target group of 1765). The median HbA(1c) level was 8.2% (interquartile range, 7.6%-9.1%). Significant predictors of HbA1c level in a multiple regression model were duration (b = 0.05; 95% CI, 0.02-0.07) and insulin dose/kg (b = 0.46; 95% CI, 0.27-0.66). At least one episode of severe hypoglycaemia in the previous three months was reported in 6.7%, and the rate of severe hypoglycaemia was 36/100 patient-years. Significant predictors of hypoglycaemia in a Poisson regression model were younger age (P = 0.03), male sex (P = 0.04), longer diabetes duration (P = 0.02), and > 3 daily insulin injections (P = 0.02), but not HbA(1c) level. Children with diabetes had higher BMI standard deviation scores compared with population standards, and those in the highest quartile of BMI standard deviation score were younger, had shorter diabetes duration and had higher HbA(1c) level.
Many children and adolescents with type 1 diabetes have suboptimal glycaemic control, placing them at high risk of developing microvascular complications. Those with longer diabetes duration are at increased risk of suboptimal glycaemic control and severe hypoglycaemia and should be targeted for interventional strategies.
对新南威尔士州（NSW）和澳大利亚首都直辖区（ACT）1型糖尿病儿童及青少年的血糖控制情况和严重低血糖发生率进行审查。
一项多中心、基于人群的横断面研究，时间为1999年9月1日至12月31日。
从新南威尔士州和澳大利亚首都直辖区的3家医院儿科糖尿病科室、4家城市私立儿科诊所及18家区域外展诊所中识别出1190名年龄在1.2 - 15.8岁的1型糖尿病儿童及青少年。
糖化血红蛋白（HbA1c）水平和严重低血糖发生率（定义为意识丧失或癫痫发作）。
应答率为67%（目标群体1765人中的1190人）。糖化血红蛋白（HbA1c）水平的中位数为8.2%（四分位间距，7.6% - 9.1%）。多元回归模型中糖化血红蛋白（HbA1c）水平的显著预测因素为病程（b = 0.05；95%可信区间，0.02 - 0.07）和胰岛素剂量/千克（b = 0.46；95%可信区间，0.27 - 0.66）。在前三个月中，6.7%的患者报告至少发生过一次严重低血糖，严重低血糖发生率为36/100患者年。泊松回归模型中低血糖的显著预测因素为年龄较小（P = 0.03）、男性（P = 0.04）、糖尿病病程较长（P = 0.02）及每日胰岛素注射次数>3次（P = 0.02），但与糖化血红蛋白（HbA1c）水平无关。与人群标准相比，糖尿病患儿的体重指数标准差评分更高，且体重指数标准差评分处于最高四分位数的患儿年龄更小、糖尿病病程更短、糖化血红蛋白（HbA1c）水平更高。
许多1型糖尿病儿童及青少年血糖控制欠佳，使其发生微血管并发症的风险较高。糖尿病病程较长的患者血糖控制欠佳及发生严重低血糖的风险增加，应针对其采取干预策略。
