de Beaufort Carine E, Swift Peter G F, Skinner Chas T, Aanstoot Henk J, Aman Jan, Cameron Fergus, Martul Pedro, Chiarelli Francesco, Daneman Dennis, Danne Thomas, Dorchy Harry, Hoey Hilary, Kaprio Eero A, Kaufman Francine, Kocova Mirjana, Mortensen Henrik B, Njølstad Pal R, Phillip Moshe, Robertson Kenneth J, Schoenle Eugen J, Urakami Tatsuhiko, Vanelli Maurizio
DECCP, Clinique Pédiatrique/Centre Hospitalier, Luxembourg.
Diabetes Care. 2007 Sep;30(9):2245-50. doi: 10.2337/dc07-0475. Epub 2007 May 31.
To reevaluate the persistence and stability of previously observed differences between pediatric diabetes centers and to investigate the influence of demography, language communication problems, and changes in insulin regimens on metabolic outcome, hypoglycemia, and ketoacidosis.
This was an observational cross-sectional international study in 21 centers, with clinical data obtained from all participants and A1C levels assayed in one central laboratory. All individuals with diabetes aged 11-18 years (49.4% female), with duration of diabetes of at least 1 year, were invited to participate. Fourteen of the centers participated in previous Hvidoere Studies, allowing direct comparison of glycemic control across centers between 1998 and 2005.
Mean A1C was 8.2 +/- 1.4%, with substantial variation between centers (mean A1C range 7.4-9.2%; P < 0.001). There were no significant differences between centers in rates of severe hypoglycemia or diabetic ketoacidosis. Language difficulties had a significant negative impact on metabolic outcome (A1C 8.5 +/- 2.0% vs. 8.2 +/- 1.4% for those with language difficulties vs. those without, respectively; P < 0.05). After adjustement for significant confounders of age, sex, duration of diabetes, insulin regimen, insulin dose, BMI, and language difficulties, the center differences persisted, and the effect size for center was not reduced. Relative center ranking since 1998 has remained stable, with no significant change in A1C.
Despite many changes in diabetes management, major differences in metabolic outcome between 21 international pediatric diabetes centers persist. Different application between centers in the implementation of insulin treatment appears to be of more importance and needs further exploration.
重新评估先前观察到的儿科糖尿病中心之间差异的持续性和稳定性，并调查人口统计学、语言沟通问题以及胰岛素治疗方案的变化对代谢结局、低血糖和酮症酸中毒的影响。
这是一项在21个中心开展的观察性横断面国际研究，从所有参与者处获取临床数据，并在一个中央实验室检测糖化血红蛋白（A1C）水平。邀请了所有年龄在11 - 18岁、糖尿病病程至少1年的糖尿病患者（女性占49.4%）参与。其中14个中心参与过先前的赫维多尔研究，从而能够直接比较1998年至2005年间各中心的血糖控制情况。
平均A1C为8.2±1.4%，各中心之间存在显著差异（平均A1C范围为7.4 - 9.2%；P<0.001）。各中心在严重低血糖或糖尿病酮症酸中毒发生率方面无显著差异。语言困难对代谢结局有显著负面影响（有语言困难者的A1C为8.5±2.0%，无语言困难者为8.2±1.4%；P<0.05）。在对年龄、性别、糖尿病病程、胰岛素治疗方案、胰岛素剂量、体重指数和语言困难等显著混杂因素进行调整后，中心间差异依然存在，且中心的效应量未降低。自1998年以来各中心的相对排名保持稳定，A1C无显著变化。
尽管糖尿病管理发生了诸多变化，但21个国际儿科糖尿病中心在代谢结局方面的主要差异依然存在。各中心在胰岛素治疗实施方面的不同应用似乎更为重要，需要进一步探索。
