Barbara Davis Centre for Childhood Diabetes, Aurora, CO, USA.
Diabetologia. 2014 Aug;57(8):1578-85. doi: 10.1007/s00125-014-3272-2. Epub 2014 Jun 4.
AIMS/HYPOTHESIS: The study aimed to compare participant characteristics, treatment modalities and clinical outcomes in registry participants less than 6 years old.
Participant characteristics, treatment modalities and clinical outcomes (HbA1c, severe hypoglycaemia [SH] and diabetic ketoacidosis [DKA]) as well as frequencies of attaining HbA1c goals in line with the International Society for Pediatric and Adolescent Diabetes (<7.5% [<58 mmol/mol]) and ADA (<8.5% [<69 mmol/mol]) were compared.
Insulin pump use was more frequent (74% vs 50%, p < 0.001) and HbA1c levels lower in the Prospective Diabetes Follow-up Registry (DPV) than in the T1D Exchange (T1DX) (mean 7.4% vs 8.2%, p < 0.001). A lower HbA1c level was seen in the DPV compared with the T1DX for both pump users (p < 0.001) and injection users (p < 0.001). More children from DPV were meeting the recommended HbA1c goals, compared with children from T1DX (HbA1c <7.5%: 56% vs 22%, p < 0.001; HbA1c <8.5%: 90% vs 66%, p < 0.001). The adjusted odds of having an HbA1c level <7.5% or <8.5% were 4.2 (p < 0.001) and 3.6 (p < 0.001) higher for the DPV than the T1DX, respectively. The frequency of SH did not differ between registries or by HbA1c, whereas the frequency of DKA was higher for the T1DX and greater in those with higher HbA1c levels.
CONCLUSIONS/INTERPRETATION: DPV data indicate that an HbA1c of <7.5% can frequently be achieved in children with type 1 diabetes who are under 6 years old. An improved metabolic control of type 1 diabetes in young patients appears to decrease the risk of DKA without increasing SH. The greater frequency of suboptimal control in young patients in the T1DX compared with the DPV is not fully explained by a less frequent use of insulin pumps and may relate to the higher HbA1c targets that are recommended for this age group in the USA.
目的/假设：本研究旨在比较注册参与者中年龄小于 6 岁的参与者的特征、治疗方式和临床结局。
比较参与者特征、治疗方式和临床结局（HbA1c、严重低血糖[SH]和糖尿病酮症酸中毒[DKA]）以及达到符合国际儿童青少年糖尿病协会（<7.5% [<58mmol/mol]）和美国糖尿病协会（<8.5% [<69mmol/mol]）HbA1c 目标的频率。
与 T1D Exchange（T1DX）相比，前瞻性糖尿病随访登记（DPV）中胰岛素泵的使用率更高（74% vs 50%，p<0.001），HbA1c 水平更低（7.4% vs 8.2%，p<0.001）。与 T1DX 相比，DPV 中使用胰岛素泵（p<0.001）和注射治疗（p<0.001）的患者的 HbA1c 水平均更低。与 T1DX 相比，更多来自 DPV 的儿童达到了推荐的 HbA1c 目标，HbA1c<7.5%：56% vs 22%，p<0.001；HbA1c<8.5%：90% vs 66%，p<0.001）。与 T1DX 相比，DPV 的 HbA1c<7.5%或<8.5%的调整后优势比分别为 4.2（p<0.001）和 3.6（p<0.001）。两个登记处或按 HbA1c 分层，SH 的频率无差异，而 DKA 的频率更高，且在 HbA1c 水平较高的患者中更为常见。
结论/解释：DPV 数据表明，年龄小于 6 岁的 1 型糖尿病儿童通常可以达到 HbA1c<7.5%。年轻患者 1 型糖尿病代谢控制的改善似乎降低了 DKA 的风险，而不会增加 SH。与 DPV 相比，T1DX 中年轻患者的控制不佳更为常见，这不能完全用胰岛素泵使用频率较低来解释，可能与美国推荐的该年龄段更高的 HbA1c 目标有关。
