Children's Policy Research Unit, Great Ormond Street Institute of Child Health, University College London, London, UK.
Department of Paediatrics, University of Cambridge, Cambridge, UK.
Pediatr Diabetes. 2018 Feb;19(1):18-26. doi: 10.1111/pedi.12530. Epub 2017 May 10.
Early glycemic control is associated with reduced future vascular complications risk in type 1 diabetes (T1D). The aim of this study was to systematically review evidence on the predictors of glycemic control within 12 months of diagnosis of childhood onset T1D. Inclusion criteria for the electronic search were: interventional and observational studies that assessed and quantified an association between the predictor and glycemic control within 12 months of diagnosis of childhood onset T1D. A total of 17 915 articles were identified from 6 databases and 20 studies were finally included in the analysis. Harvest plots and narrative synthesis were used to summarize data from intervention (n = 0), prospective/retrospective cohort (n = 15), and cross-sectional (n = 5) studies. Significant predictors of poorer glycemic control 0 to 3 months after diagnosis were older age and female gender. Non-white ethnicity, diabetes autoantibody positivity, measures of deprivation, and non-private health insurance were potential predictors. Predictors of poorer glycemic control 4 to 12 months after diagnosis were: older age, non-white ethnicity, a single parent family, high hemoglobin A1c (HbA1c) levels at diagnosis, longer T1D duration, and non-intensive insulin therapy. Potential predictors included: family with health issues, clinical factors, and comorbidities at diagnosis. Most significant predictors of poor glycemic control within 12 months of diagnosis of childhood onset T1D are non-modifiable. These factors need to be recognized and addressed through individualized and multidisciplinary diabetes care. Further research is required to confirm the association of potential predictors with early glycemic control.
早期血糖控制与 1 型糖尿病（T1D）未来血管并发症风险降低有关。本研究旨在系统回顾儿童期 T1D 诊断后 12 个月内血糖控制的预测因素。电子搜索的纳入标准为：评估和量化预测因素与儿童期 T1D 诊断后 12 个月内血糖控制之间关联的干预和观察性研究。从 6 个数据库中确定了 17915 篇文章，最终有 20 项研究纳入分析。采用收割图和叙述性综合方法总结干预（n=0）、前瞻性/回顾性队列（n=15）和横断面（n=5）研究的数据。诊断后 0 至 3 个月血糖控制较差的显著预测因素为年龄较大和女性。非白种人、糖尿病自身抗体阳性、贫困程度指标和非私人医疗保险可能是预测因素。诊断后 4 至 12 个月血糖控制较差的预测因素为：年龄较大、非白种人、单亲家庭、诊断时高血红蛋白 A1c（HbA1c）水平、T1D 持续时间较长、非强化胰岛素治疗。潜在的预测因素包括：家庭健康问题、诊断时的临床因素和合并症。儿童期 T1D 诊断后 12 个月内血糖控制较差的最显著预测因素是非可改变的。需要通过个体化和多学科的糖尿病护理来认识和解决这些因素。需要进一步研究来证实潜在预测因素与早期血糖控制的关联。
