Castensøe-Seidenfaden P, Jensen A K, Smedegaard H, Hommel E, Husted G R, Pedersen-Bjergaard U, Teilmann G
Paediatric and Adolescent Department, Nordsjaellands Hospital, Hillerød, Denmark.
Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
Diabet Med. 2017 May;34(5):667-675. doi: 10.1111/dme.13318. Epub 2017 Mar 4.
To describe and compare changes in glycaemic control in young people with Type 1 diabetes over time between the last 2 years in paediatric care and the first 2 years in adult care and to identify risk factors for poor glycaemic control.
Our retrospective cohort study followed participants aged 14-22 years from 2 years before to 2 years after transfer from paediatric to adult care. Changes in glycaemic control were calculated using repeated measurements. We adjusted for gender, age at diabetes onset, age at transfer, duration of diabetes at transfer, gap (amount of time) between last paediatric and first adult visit, comorbidity, learning disability and/or mental health conditions and family structure. We examined associations between acute hospital admissions, low visit attendance rate, loss to follow-up and baseline HbA level.
Among 126 participants, the mean HbA level was 80 mmol/mol (9.4%) pre-transfer but decreased by an average of 3 mmol/mol (0.3%) each year post-transfer (P = 0.005). Young people with a learning disability and/or a mental health condition had worse glycaemic control (P = 0.041) and the mean HbA of those with divorced parents was 14 mmol/mol (1.2%) higher (P = 0.014). Almost one-third of participants were admitted to the hospital for acute diabetes care. Low visit attendance rate, high baseline HbA level, learning disability and/or mental health conditions and divorced parents predicted acute hospital admissions.
Glycaemic control improved significantly after transfer to adult care, but the mean HbA level remained high. Future interventions should focus on young people with divorced parents, those with a learning disability and/or mental health condition and those who do not attend clinical visits to improve HbA levels and thereby reduce hospitalization rates.
描述并比较1型糖尿病青少年在儿科护理的最后2年和成人护理的前2年期间血糖控制随时间的变化，并确定血糖控制不佳的风险因素。
我们的回顾性队列研究跟踪了14至22岁的参与者，从从儿科护理转至成人护理前2年到转至成人护理后2年。使用重复测量来计算血糖控制的变化。我们对性别、糖尿病发病年龄、转至成人护理时的年龄、转至成人护理时的糖尿病病程、最后一次儿科就诊和第一次成人就诊之间的间隔（时间量）、合并症、学习障碍和/或心理健康状况以及家庭结构进行了调整。我们研究了急性住院、低就诊率、失访与基线糖化血红蛋白（HbA）水平之间的关联。
在126名参与者中，转至成人护理前糖化血红蛋白（HbA）的平均水平为80 mmol/mol（9.4%），但转至成人护理后每年平均下降3 mmol/mol（0.3%）（P = 0.005）。有学习障碍和/或心理健康状况的年轻人血糖控制较差（P = 0.041），父母离异的年轻人糖化血红蛋白（HbA）的平均水平高14 mmol/mol（1.2%）（P = 0.014）。近三分之一的参与者因急性糖尿病护理而住院。低就诊率、高基线糖化血红蛋白（HbA）水平、学习障碍和/或心理健康状况以及父母离异可预测急性住院。
转至成人护理后血糖控制有显著改善，但糖化血红蛋白（HbA）的平均水平仍然较高。未来的干预措施应侧重于父母离异的年轻人、有学习障碍和/或心理健康状况以及那些不参加临床就诊的年轻人，以改善糖化血红蛋白（HbA）水平，从而降低住院率。
