Szadkowska Agnieszka, Michalak Arkadiusz, Chylińska-Frątczak Aneta, Baranowska-Jaźwiecka Anna, Koptas Marta, Pietrzak Iwona, Hogendorf Anna, Zmysłowska Agnieszka, Młynarski Wojciech, Mianowska Beata
Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland, E-mail:
Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland.
J Pediatr Endocrinol Metab. 2018 Oct 25;31(10):1073-1079. doi: 10.1515/jpem-2018-0098.
Background Therapeutic goals have been established to decrease the risk of long-term complications of type 1 diabetes (T1DM). The effects of these guidelines should be constantly evaluated. Hence, the present study examines the frequency at which children with T1DM treated by one of the Polish reference centers complied with the therapeutic targets issued in 2014 by the International Society for Pediatric and Adolescent Diabetes (ISPAD) and by the Diabetes Poland (PTD). Methods A retrospective analysis (years 2011-2014) was performed in patients with T1DM aged 6.5-18 years, with diabetes duration >12 months and no change of insulin regimen within 6 months. Collected data included insulin therapy regimen, weight, height, blood pressure, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and glycated hemoglobin (HbA1c) level from the last hospitalization. Results The records of 447 patients (260 boys, 299 treated with insulin pump) were analyzed. All ISPAD goals were achieved by 123 (27.5%) patients, but only 43 (9.6%) met all PTD targets. Optimal HbA1c was achieved by 224 (50.1%) according to ISPAD criteria (HbA1c<7.5%) and by 87 (19.6%) patients according to PTD (HbA1c≤6.5%). Obesity was diagnosed in 11.6% of the patients; 19.7% of the patients were overweight. In logistic regression, patient age was the only independent predictor of failing to achieve complete T1DM control (p=0.001, OR=1.12 [1.05-1.23]) and optimal HbA1c (p=0.01, OR=1.1 [1.0-1.2]) according to ISPAD guidelines. Moreover, girls had a greater risk of failing body mass index (BMI) targets (PTD: p=0.002, OR=2.16; ISPAD: p=0.0001, OR=3.37) and LDL-C targets (p=0.005, OR=1.8) than boys. Conclusions Overall, control of vascular risk factors in Polish children with T1DM is unsatisfactory. While too few children are achieving the HbA1c target set by PTD, it is possible that such strict national target helps half of the Polish school-age patients achieve ISPAD-issued aim which is more liberal. High prevalence of overweight among children with T1DM warrants initiatives focused not only on glycemic control but also on motivation of patients to lead a healthy lifestyle.
背景 已制定治疗目标以降低1型糖尿病（T1DM）长期并发症的风险。应持续评估这些指南的效果。因此，本研究调查了波兰一家参考中心治疗的T1DM儿童遵守国际儿童和青少年糖尿病学会（ISPAD）及波兰糖尿病协会（PTD）于2014年发布的治疗目标的频率。方法 对年龄在6.5 - 18岁、糖尿病病程>12个月且6个月内胰岛素治疗方案无变化的T1DM患者进行回顾性分析（2011 - 2014年）。收集的数据包括胰岛素治疗方案、体重、身高、血压、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、甘油三酯（TG）以及上次住院时的糖化血红蛋白（HbA1c）水平。结果 分析了447例患者（260名男孩，299名使用胰岛素泵治疗）的记录。123例（27.5%）患者实现了所有ISPAD目标，但只有43例（9.6%）达到了所有PTD目标。根据ISPAD标准（HbA1c<7.5%），224例（50.1%）患者达到了最佳HbA1c水平；根据PTD标准（HbA1c≤6.5%），87例（19.6%）患者达到了该水平。11.6%的患者被诊断为肥胖；19.7%的患者超重。在逻辑回归分析中，患者年龄是未实现T1DM完全控制（p = 0.001，OR = 1.12 [1.05 - 1.23]）以及未达到ISPAD指南规定的最佳HbA1c水平（p = 0.01，OR = 1.1 [1.0 - 1.2]）的唯一独立预测因素。此外，女孩未达到体重指数（BMI）目标（PTD：p = 0.002，OR = 2.16；ISPAD：p = 0.0001，OR = 3.37）和LDL-C目标（p = 0.005，OR = 1.8）的风险高于男孩。结论 总体而言，波兰T1DM儿童血管危险因素的控制情况并不理想。虽然达到PTD设定的HbA1c目标的儿童过少，但如此严格的国家目标可能有助于一半的波兰学龄患者实现更为宽松的ISPAD目标。T1DM儿童中超重的高患病率表明，不仅要关注血糖控制，还应激励患者养成健康的生活方式。
