Kim Hyuntae, Elmi Angelo, Henderson Celia L, Cogen Fran R, Kaplowitz Paul B
George Washington University School of Public Health and Health Services, Department of Epidemiology and Biostatistics, Washington, DC 20010, USA.
J Clin Res Pediatr Endocrinol. 2012 Jun;4(2):82-8. doi: 10.4274/jcrpe.663.
This study aims to determine the relationship between the duration of persistent poor glycemic control in type 1 diabetes mellitus (T1DM) children and the likelihood of subsequent improvement.
A retrospective cohort study was conducted on T1DM patients aged 6-18 years, followed for at least six visits at Children's National Medical Center (Washington, DC) with at least one hemoglobin A1c (HbA1c) ≥ 10% after the first year since the initial visit (n=151). Medical records of patients with subsequently improved glycemic control were reviewed (n=39).
Patients aged 12-18 years, females, and Medicaid patients were twice as likely to be in persistently poor control as patients aged 6-11 years, males, and privately insured patients, respectively. Each additional visit with HbA1c ≥ 10% and one percentage point increase in the mean HbA1c reduced the likelihood of subsequent improvement by 20% and 50%, respectively. Of the 39 patients with improved control, only 5 (13%) sustained their improvement for ≥ 2 years. Multiple contributing factors for improved control were identified, but no one factor explained improved control in > 25% of patients.
This study suggests that the longer the duration of poor control, the more difficult it is to reverse the underlying factors of poor diabetes management. Strategies to improve regular clinic attendance along with reinforcement of changes which resulted in improved control are critical. Adolescents, females, and Medicaid patients in particular should be targeted for sustained intervention.
本研究旨在确定1型糖尿病(T1DM)儿童持续性血糖控制不佳的持续时间与后续改善可能性之间的关系。
对6至18岁的T1DM患者进行了一项回顾性队列研究,这些患者在儿童国家医疗中心(华盛顿特区)至少随访了6次,自初次就诊后第一年至少有一次糖化血红蛋白(HbA1c)≥10%(n = 151)。对血糖控制随后得到改善的患者的病历进行了审查(n = 39)。
12至18岁的患者、女性患者和医疗补助患者持续性血糖控制不佳的可能性分别是6至11岁患者、男性患者和私人保险患者的两倍。每次糖化血红蛋白≥10%的额外就诊以及平均糖化血红蛋白每增加一个百分点,后续改善的可能性分别降低20%和50%。在39例血糖控制得到改善的患者中,只有5例(13%)持续改善≥2年。确定了多个有助于改善控制的因素,但没有一个因素能解释超过25%的患者的控制改善情况。
本研究表明,控制不佳的持续时间越长,扭转糖尿病管理不佳的潜在因素就越困难。改善定期门诊就诊以及强化导致控制改善的改变的策略至关重要。尤其应针对青少年、女性和医疗补助患者进行持续干预。