Vanelli Maurizio, Cangelosi Antonina Marta, Fanciullo Lavinia, Scarabello Chiara, Monti Giorgia, Gkliati Dimitra, Mastrorilli Carla, Iovane Brunella, Chiari Giovanni
Regional Center for Children and Adolescents with Diabetes, Children Hospital, University Hospital, Parma, Italy.
Acta Biomed. 2012 Apr;83(1):30-5.
Newly diagnosed children with type 1 diabetes from ethnic minorities are a growing presence in outpatient pediatric clinics, and are reported as a group at risk of poor metabolic control. In the present study we investigated the barriers affecting chances of minority diabetic children to achieve the same metabolic targets of native peers with type 1 diabetes.
The study investigated 35 children from ethnic minorities (group 1) admitted to the Children University Hospital of Parma, Italy, from 1st January 2000 to December 31st, 2011, and data concerning current age, gender, ethnicity, age at diabetes onset, HbA1c, DKA severity degree at diagnosis, insulin therapy, annual number of out patient clinic visits, number of admissions for acute decompensation, and treatment cost. A short questionnaire on background, family situation, difficulties in diabetes monitoring, and outpatient clinic procedures completed the study. The results were compared with data collected from 30 matched native peers (group 2).
Mean HbA1c level at admittance was higher in Group 1 (11.8 +/- 1.0%) than in Group 2 (9.0 +/- 2.2%; p=0.000). The differences were confirmed when HbAlc mean cumulative values (8.6 +/- 2.1 vs 7.6 +/- 1.1; p=0.022) were calculated. Group 1 children at admission showed poorer metabolic conditions and longer stay at hospital (16 +/- 3 days) than Group 2 patients (8 +/- 2 days; p=0.000). The total costs for DKA treatment and family education resulted higher in group 1 (+54%) than in group 2 patients. Discontinuous capillary blood glucose monitoring and outpatient clinic visits missed were more frequent in Group 1 than in group 2 patients. Thirteen patients in group 1 needed a re-admittance to hospital because of a hypoglycemia (5 cases) or a hyperglycemia (8 cases). The same episodes were not recorded in group 2 patients. Most of parents expressed the wish to be supported with educational material in their own language.
Children with TDM belonging to an ethnic minority had poorer metabolic control compared with native patients. This results from several cultural, educational, economic deficiencies which influence their family life and probably reduced their chances to obtain a better control.
新诊断的1型糖尿病少数民族儿童在儿科门诊中所占比例日益增加，据报道这一群体存在代谢控制不佳的风险。在本研究中，我们调查了影响少数民族糖尿病儿童实现与1型糖尿病本地同龄人相同代谢目标的机会的障碍因素。
本研究调查了2000年1月1日至2011年12月31日期间入住意大利帕尔马儿童医院的35名少数民族儿童（第1组），收集了他们目前的年龄、性别、种族、糖尿病发病年龄、糖化血红蛋白（HbA1c）、诊断时糖尿病酮症酸中毒（DKA）严重程度、胰岛素治疗情况、门诊年度就诊次数、急性失代偿住院次数以及治疗费用等数据。通过一份关于背景、家庭情况、糖尿病监测困难以及门诊程序的简短问卷完成了本研究。将结果与从30名匹配的本地同龄人（第2组）收集的数据进行比较。
第1组入院时的平均HbA1c水平（11.8±1.0%）高于第2组（9.0±2.2%；p = 0.000）。计算HbAlc平均累积值时（8.6±2.1对7.6±1.1；p = 0.022），差异得到证实。第1组儿童入院时的代谢状况较差，住院时间（16±3天）比第2组患者（8±2天；p = 0.000）长。第1组DKA治疗和家庭教育的总成本比第2组患者高（+54%）。第1组间断性毛细血管血糖监测和错过门诊就诊的情况比第2组患者更频繁。第1组中有13名患者因低血糖（5例）或高血糖（8例）需要再次住院。第2组患者未记录到相同情况。大多数家长表示希望获得用他们自己语言编写的教育材料的支持。
与本地患者相比，属于少数民族的1型糖尿病儿童代谢控制较差。这是由多种文化、教育、经济方面的不足导致的，这些不足影响了他们的家庭生活，可能也减少了他们获得更好控制的机会。
