From the Department of Pediatrics, The Brooklyn Hospital Center, Brooklyn, NY.
Pediatr Emerg Care. 2023 Apr 1;39(4):216-218. doi: 10.1097/PEC.0000000000002859. Epub 2023 Jan 22.
Glycosylated hemoglobin (HbA1c) reflects how well blood glucose is controlled and is one of the strongest predictors of chronic complications of diabetes mellitus. The degree of acidosis helps determine the severity of diabetic ketoacidosis (DKA) (mild: pH 7.2-7.3; moderate: pH 7.1-7.2; severe: pH <7.1) and guides the level of care and predicts outcome. Many studies have implicated that higher HbA1c levels lead to recurrent DKA. However, there is no description of the association of higher HbA1c with the severity of DKA. One hundred thirty-eight electronic medical records of patients aged 1 to 21 years admitted to the pediatric intensive care unit with DKA between 2011 and 2015 were analyzed. We excluded 50 patients because the HbA1c level was not available. Spearman correlation analyzed the data for 88 patients included in the study. The mean HbA1c was 13.3, with female patients having more admissions compared with male patients (58% vs 42%). The age group from 13 to 21 years accounted for 77.3% of the patients. The duration of type 1 diabetes mellitus did not affect the HbA1c level. Likewise, the blood glucose and serum creatinine level did not show a statistical correlation with blood pH levels. Mean HbA1c for mild, moderate, and severe DKA groups were 11.4%, 12.2%, and 14.8%, respectively. Blood pH and HbA1c returned a negative correlation (correlation coefficient, -0.557; P = 0.005). The HbA1c level correlated positively with the 3 groups of DKA (correlation coefficient, 0.595; P = 0.01). A higher A 1c was associated with more severe DKA.
糖化血红蛋白（HbA1c）反映了血糖控制的情况，是糖尿病慢性并发症的最强预测指标之一。酸中毒的程度有助于确定糖尿病酮症酸中毒（DKA）的严重程度（轻度：pH 值 7.2-7.3；中度：pH 值 7.1-7.2；重度：pH 值 <7.1），并指导治疗水平并预测结局。许多研究表明，HbA1c 水平升高与 DKA 反复发作有关。然而，目前尚无描述较高的 HbA1c 与 DKA 严重程度之间的关联。对 2011 年至 2015 年期间因 DKA 入住儿科重症监护病房的 138 名 1 至 21 岁患者的电子病历进行了分析。我们排除了 50 名患者，因为 HbA1c 水平不可用。对纳入研究的 88 名患者的数据进行 Spearman 相关性分析。平均 HbA1c 为 13.3，女性患者入院次数多于男性患者（58% vs 42%）。年龄在 13 至 21 岁的患者占 77.3%。1 型糖尿病的病程长短并不影响 HbA1c 水平。同样，血糖和血清肌酐水平与血液 pH 值之间也没有统计学相关性。轻度、中度和重度 DKA 组的平均 HbA1c 分别为 11.4%、12.2%和 14.8%。血液 pH 值和 HbA1c 呈负相关（相关系数-0.557；P=0.005）。HbA1c 水平与 DKA 的 3 组呈正相关（相关系数 0.595；P=0.01）。较高的 HbA1c 与更严重的 DKA 相关。
