Department of Endocrinology, Genetics and Metabolism, Children's Hospital of Soochow University, Suzhou, China.
Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China.
Front Endocrinol (Lausanne). 2021 Apr 12;12:651589. doi: 10.3389/fendo.2021.651589. eCollection 2021.
To explore the glycemic control [represented by glycated hemoglobin (HbA1c) concentrations] in children with diabetes mellitus (DM) in east China and middle- and low-income countries, from 2010 to 2019.
Retrospective data of children with DM from two hospital-based health records were reviewed. Data on HbA1c concentrations, hospitalization due to diabetic ketoacidosis, and patient demographics were collected and analyzed. A systematic review was subsequently performed to analyze publications that report HbA1c concentrations in patients aged <18 years. Patients' characteristics extracted from each publication were used to generate simulated individual data for pooled analysis. HbA1c estimates were derived from steady-state iterations.
Data of 843 diabetic children (aged 11.2 ± 3.9 years) with 2,658 HbA1c measures were retrieved from the two hospitals during the period 2010-2020. The duration of diabetes in the patients was 4.4 ± 2.8 years, and their HbA1c was 8.1 ± 2.2%. Patients who were internal migrants had significantly higher HbA1c concentration than resident patients (8.4 7.9%). The literature review yielded 1,164 publications, and the majority (74.1%) of patient data were published in high-income countries. The patient data extracted from these publications generated 486,416 HbA1c concentration estimates between 2005 and 2019. The average HbA1c concentration during the 15 years was 9.07 ± 2.15%. The mean HbA1c concentrations among children were 8.23, 8.73, 9.20, and 10.11% in high-income country (HIC), upper-middle income country (UMIC), lower-middle income country (LMIC), and low-income country (LIC) respectively. The mean rate of optimized glycemic control (HbA1c <7.5%) among children was 32.4, 27.5, 21.7, and 12.7% in HIC, UMIC, LMIC, and LIC, respectively.
The current study indicated that there is substantial room for improvement in glycemic control in children with DM worldwide, especially in middle- and low-income countries.
探究 2010 年至 2019 年期间中国东部和中低收入国家儿童糖尿病患者（DM）的血糖控制情况（以糖化血红蛋白（HbA1c）浓度表示）。
回顾了来自两家医院健康记录的 DM 儿童的回顾性数据。收集并分析了 HbA1c 浓度、因糖尿病酮症酸中毒住院以及患者人口统计学数据。随后进行了系统评价，分析了报告年龄<18 岁患者 HbA1c 浓度的出版物。从每个出版物中提取患者特征，用于生成汇总分析的模拟个体数据。HbA1c 估计值来自稳态迭代。
从 2010 年至 2020 年期间的两家医院中检索到 843 名糖尿病儿童（年龄 11.2±3.9 岁）的 2658 项 HbA1c 测量值。患者的糖尿病病程为 4.4±2.8 年，HbA1c 为 8.1±2.2%。移民患者的 HbA1c 浓度显著高于本地患者（8.4±7.9%）。文献综述共获得 1164 篇出版物，其中大部分（74.1%）患者数据来自高收入国家。从这些出版物中提取的患者数据在 2005 年至 2019 年期间生成了 486416 项 HbA1c 浓度估计值。15 年间的平均 HbA1c 浓度为 9.07±2.15%。高收入国家（HIC）、中上收入国家（UMIC）、中下收入国家（LMIC）和低收入国家（LIC）儿童的平均 HbA1c 浓度分别为 8.23%、8.73%、9.20%和 10.11%。HIC、UMIC、LMIC 和 LIC 儿童的优化血糖控制（HbA1c<7.5%）的平均达标率分别为 32.4%、27.5%、21.7%和 12.7%。
本研究表明，全球范围内儿童糖尿病患者的血糖控制仍有很大的改善空间，尤其是中低收入国家。
