Povlsen Lene, Olsen Birthe, Ladelund Steen
Department of Paediatrics, Glostrup University Hospital, Copenhagen, Denmark.
J Adv Nurs. 2005 Jun;50(6):576-82. doi: 10.1111/j.1365-2648.2005.03443.x.
This paper reports an investigation to establish whether metabolic control is different in children and adolescents from ethnic minorities with type 1 diabetes compared with young Danish patients, and to learn about factors affecting their opportunities to achieve good metabolic control.
The prevalence of diabetes in children and adolescents from ethnic minorities in Denmark is increasing. Having a different ethnic background has frequently been described as a risk factor for poor metabolic control, but whether the risk is represented by the ethnicity and immigration itself or in combination with other factors is unclear.
The study included data (gender, age, diabetes duration HbA(1c), number of incidents of severe hypoglycaemia and ketoacidosis) from a national register including 919 Danish and 58 children and adolescents from ethnic minorities, questionnaires to all 20 Danish paediatric diabetes centres and questionnaires to 38 families of other ethnic backgrounds completed by professional interpreters. The study was conducted in 2001-2002.
HbA(1c) was significantly higher in children and adolescents from ethnic minorities (mean 9.05 +/- 1.4%) compared with Danish patients (mean 8.62 +/- 1.3%; P = 0.018). There was no significant difference in HbA(1c) among the different ethnic groups, nor in the prevalence of severe hypoglycaemia or ketoacidosis. Patients from different ethnic minorities were unevenly distributed throughout the country, and generally the centres provided limited specialized knowledge and support. The questionnaires completed by the parents revealed limited schooling, lack of professional education and a major need for interpreters; these characteristics were especially prevalent among the mothers.
Young patients from ethnic minorities have significantly poorer metabolic control compared with Danish patients, and patients with an immigrant background are seen as a vulnerable group with different needs and probably fewer chances of achieving good control. Special education for health care professionals as well as projects to improve methods, quality and knowledge should be encouraged in order to provide tailored support to members of individual ethnic groups. We recommend that the use of professional interpreters should become the gold standard in health care provision to all immigrant families.
本文报告一项调查，以确定与丹麦年轻患者相比，1型糖尿病的少数民族儿童和青少年的代谢控制情况是否不同，并了解影响他们实现良好代谢控制机会的因素。
丹麦少数民族儿童和青少年的糖尿病患病率正在上升。不同的种族背景经常被描述为代谢控制不佳的危险因素，但这种风险是由种族和移民本身导致，还是与其他因素共同作用尚不清楚。
该研究纳入了来自国家登记册的数据（性别、年龄、糖尿病病程、糖化血红蛋白、严重低血糖和酮症酸中毒事件数量），其中包括919名丹麦儿童和青少年以及58名少数民族儿童和青少年，向丹麦所有20个儿科糖尿病中心发放了问卷，并通过专业口译员向38个其他种族背景的家庭发放了问卷。该研究于2001年至2002年进行。
与丹麦患者（平均8.62±1.3%）相比，少数民族儿童和青少年的糖化血红蛋白显著更高（平均9.05±1.4%；P = 0.018）。不同种族群体之间的糖化血红蛋白、严重低血糖或酮症酸中毒患病率没有显著差异。不同少数民族的患者在全国分布不均，而且各中心普遍提供的专业知识和支持有限。家长填写的问卷显示，他们受教育程度有限、缺乏职业教育且对口译员有很大需求；这些特征在母亲中尤为普遍。
与丹麦患者相比，少数民族年轻患者的代谢控制明显较差，有移民背景的患者被视为一个弱势群体，他们有不同的需求，实现良好控制的机会可能更少。应鼓励对医疗保健专业人员进行特殊教育，以及开展改善方法、质量和知识的项目，以便为各个种族群体的成员提供量身定制的支持。我们建议，在为所有移民家庭提供医疗服务时，使用专业口译员应成为黄金标准。
