Choleau C, Maitre J, Elie C, Barat P, Bertrand A M, de Kerdanet M, Le Tallec C, Nicolino M, Tubiana-Rufi N, Levy-Marchal C, Cahané M, Robert J-J
L'aide aux jeunes diabétiques (AJD), 9, avenue Pierre-de-Coubertin, 75013 Paris, France.
L'aide aux jeunes diabétiques (AJD), 9, avenue Pierre-de-Coubertin, 75013 Paris, France; Diabète de l'enfant et l'adolescent, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Université René Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France.
Arch Pediatr. 2015 Apr;22(4):343-51. doi: 10.1016/j.arcped.2014.11.001. Epub 2014 Nov 14.
The aim of the study was to evaluate, after the first year of a national information campaign, the effect on the frequency and severity of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes (T1D) in children and adolescents in France. The following data were collected during a 2-year period in people younger than 15 years of age at diagnosis of T1D, in 146 pediatric centers: age, sex, duration of symptoms, patient's previous care, clinical and biological signs, and family history of T1D. DKA was defined as pH<7.30 or bicarbonate<15mmol/L, severe DKA as pH<7.10 or bicarbonate <5mmol/L. During the 2nd year, an information campaign targeting health professionals and families was launched with the objective of reducing the time to diagnosis. Data were compared between the year before the campaign (year 0) and the first year of the campaign (year 1). The number of new cases of T1D was 1299 for year 0 and 1247 for year 1. Between year 0 and year 1, the rate of DKA decreased from 43.9% to 40.5% (P=0.08), exclusively due to the decrease of severe DKA from 14.8 to 11.4% (P=0.01). In the 0- to 5-year-old and 5- to 10-year-old age groups, the relative decrease in the rate of DKA was 13% and 15%, and 23% and 41% for severe DKA, respectively. In patients referred to the hospital by a pediatrician or who came at the family's initiative, the decrease was 34% and 7%, and 39% and 32% for severe DKA, respectively. No change was observed in the 10- to 15-year-old group or in those children who were referred by a general practitioner. In multivariate analyses, a higher DKA rate was associated with the young age of the child (<5 years), being hospitalized at the parents' initiative rather than being referred by a doctor, and the absence of a family history of T1D. A higher rate of severe DKA was associated with these last two factors but not with the child's age. The frequency of DKA at diagnosis of type 1 diabetes remains high in children and adolescents, but the first year of an information campaign decreased it. The results have also helped better define the strategy and targets of the continuing prevention campaign, to more efficiently reduce the morbidity and mortality of T1D at diagnosis in children and adolescents in France.
本研究的目的是评估在开展全国性宣传活动的第一年之后，其对法国儿童和青少年1型糖尿病（T1D）诊断时糖尿病酮症酸中毒（DKA）的发生频率及严重程度的影响。在146家儿科中心，收集了确诊为T1D的15岁以下人群在2年期间的以下数据：年龄、性别、症状持续时间、患者先前的治疗情况、临床和生物学体征以及T1D家族史。DKA定义为pH<7.30或碳酸氢盐<15mmol/L，严重DKA定义为pH<7.10或碳酸氢盐<5mmol/L。在第2年，针对卫生专业人员和家庭开展了一项宣传活动，目标是缩短诊断时间。对宣传活动前一年（第0年）和活动第一年（第1年）的数据进行了比较。第0年T1D新病例数为1299例，第1年为1247例。在第0年至第1年期间，DKA发生率从43.9%降至40.5%（P=0.08），这完全是由于严重DKA从14.8%降至11.4%（P=0.01）所致。在0至5岁和5至10岁年龄组中，DKA发生率的相对下降分别为13%和15%，严重DKA的相对下降分别为23%和41%。在由儿科医生转诊至医院或由家庭主动前来就诊的患者中，严重DKA的下降分别为39%和32%，DKA的下降分别为34%和7%。在10至15岁年龄组或由全科医生转诊的儿童中未观察到变化。在多变量分析中，较高的DKA发生率与儿童年龄较小（<5岁）、由父母主动送往医院而非由医生转诊以及无T1D家族史有关。较高的严重DKA发生率与后两个因素有关，但与儿童年龄无关。儿童和青少年1型糖尿病诊断时DKA的发生频率仍然较高，但宣传活动的第一年使其有所下降。这些结果也有助于更好地确定持续预防活动的策略和目标，以更有效地降低法国儿童和青少年1型糖尿病诊断时的发病率和死亡率。
