Meyerovitch Joseph, Zlotnik Maya, Yackobovitch-Gavan Michal, Phillip Moshe, Shalitin Shlomit
The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Medicine and Community Wings, Clalit Health Services, Tel Aviv, Israel.
Department of Medicine E, Chaim Sheba Medical Center, Tel Hashomer, Israel.
J Pediatr. 2017 Sep;188:173-180.e1. doi: 10.1016/j.jpeds.2017.05.074. Epub 2017 Jul 8.
To characterize children and adolescents with type 2 diabetes mellitus (T2DM) insured by a large health maintenance organization, and to identify variables associated with treatment quality and disease outcome.
Children and adolescents diagnosed with T2DM over a 9-year period were identified from the database of Clalit Health Services, a large health maintenance organization in Israel (1 213 362 members aged 0-18 years). Demographic, anthropometric, clinical, and laboratory data were analyzed.
A total of 96 patients (47 males) met our inclusion criteria. The mean age at diagnosis of T2DM was 14.25 ± 2.51 years. At the time of diagnosis, the median hemoglobin A1c (HbA1c) level was 7.8%, and additional components of the metabolic syndrome were present in 14.9%-67.4% of the patients. At the end of the follow-up period (3.11 ± 1.75 years), >50% of the patients were being treated with insulin; the median HbA1c value was 7.97%, and 44.6% of the patients achieved the target HbA1c of <7.0%. On multivariate linear regression analysis, the variables found to predict worse glycemic control (ie, higher HbA1c) were a higher HbA1c at diagnosis, a higher body mass index SD score at diagnosis, fewer annual HbA1c tests, and Arabic ethnicity [F(4,81) = 7.139; P < .001; R = 0.271].
This population-based study of pediatric patients with T2DM demonstrates that reasonable glycemic control can be achieved in both community and outpatient hospital settings. Nevertheless, there is room for improvement in intervention programs to optimize outcomes and decrease the risk of complications.
对一家大型健康维护组织承保的2型糖尿病（T2DM）儿童和青少年进行特征描述，并确定与治疗质量和疾病转归相关的变量。
从以色列一家大型健康维护组织Clalit健康服务机构（1213362名0至18岁成员）的数据库中，识别出在9年期间被诊断为T2DM的儿童和青少年。对人口统计学、人体测量学、临床和实验室数据进行分析。
共有96例患者（47例男性）符合纳入标准。T2DM诊断时的平均年龄为14.25±2.51岁。诊断时，血红蛋白A1c（HbA1c）水平的中位数为7.8%，14.9%至67.4%的患者存在代谢综合征的其他组分。随访期末（3.11±1.75年），超过50%的患者接受胰岛素治疗；HbA1c值的中位数为7.97%，44.6%的患者达到了HbA1c<7.0%的目标。多变量线性回归分析显示，预测血糖控制较差（即HbA1c较高）的变量为诊断时较高的HbA1c、诊断时较高的体重指数标准差评分、每年较少的HbA1c检测次数以及阿拉伯族裔[F(4,81)=7.139；P<.001；R=0.271]。
这项基于人群的儿童T2DM患者研究表明，在社区和门诊医院环境中均可实现合理的血糖控制。然而，干预项目仍有改进空间，以优化转归并降低并发症风险。
