1School of Public Health, Imperial College London, London, U.K.
2NHS England, Leeds, U.K.
Diabetes Care. 2023 Jul 1;46(7):1404-1408. doi: 10.2337/dc23-0180.
Adolescence is associated with high-risk hyperglycemia. This study examines the phenomenon in a life course context.
A total of 93,125 people with type 1 diabetes aged 5 to 30 years were identified from the National Diabetes Audit and/or the National Paediatric Diabetes Audit for England and Wales for 2017/2018-2019/2020. For each audit year, the latest HbA1c and hospital admissions for diabetic ketoacidosis (DKA) were identified. Data were analyzed in sequential cohorts by year of age.
In childhood, unreported HbA1c measurement is uncommon; however, for 19-year-olds, it increases to 22.3% for men and 17.3% for women, and then reduces to 17.9% and 13.1%, respectively, for 30-year-olds. Median HbA1c for 9-year-olds is 7.6% (60 mmol/mol) (interquartile range 7.1-8.4%, 54-68 mmol/mol) in boys and 7.7% (61 mmol/mol) (8.0-8.4%, 64-68 mmol/mol) in girls, increasing to 8.7% (72 mmol/mol) (7.5-10.3%, 59-89 mmol/mol) and 8.9% (74 mmol/mol) (7.7-10.6%, 61-92 mmol/mol), respectively, for 19-year-olds before falling to 8.4% (68 mmol/mol) (7.4-9.7%, 57-83 mmol/mol) and 8.2% (66 mmol/mol) (7.3-9.7%, 56-82 mmol/mol), respectively, for 30-year-olds. Annual hospitalization for DKA rose steadily in age from 6 years (2.0% for boys, 1.4% for girls) and peaked at 19 years for men (7.9%) and 18 years for women (12.7%), reducing to 4.3% for men and 5.4% for women at age 30 years. For all ages over 9 years, the prevalence of DKA was higher in female individuals.
HbA1c and the prevalence of DKA increase through adolescence and then decline. Measurement of HbA1c, a marker of clinical review, falls abruptly in the late teenage years. Age-appropriate services are needed to overcome these issues.
青春期与高风险高血糖有关。本研究从生命历程的角度探讨了这一现象。
从英格兰和威尔士的全国糖尿病审计和/或全国儿科糖尿病审计中确定了 2017/2018 年至 2019/2020 年期间年龄在 5 至 30 岁之间的 93125 名 1 型糖尿病患者。对于每个审计年度，均确定了最新的 HbA1c 和因糖尿病酮症酸中毒 (DKA) 住院的情况。通过逐年的连续队列分析数据。
在儿童时期，未报告 HbA1c 测量并不常见；然而，对于 19 岁的人，男性的 HbA1c 增加到 22.3%，女性的 HbA1c 增加到 17.3%，然后分别减少到 30 岁时的 17.9%和 13.1%。9 岁男孩的 HbA1c 中位数为 7.6%（60mmol/mol）（四分位距 7.1-8.4%，54-68mmol/mol），女孩为 7.7%（61mmol/mol）（8.0-8.4%，64-68mmol/mol），增加到 19 岁时的 8.7%（72mmol/mol）（7.5-10.3%，59-89mmol/mol）和 8.9%（74mmol/mol）（7.7-10.6%，61-92mmol/mol），然后下降到 30 岁时的 8.4%（68mmol/mol）（7.4-9.7%，57-83mmol/mol）和 8.2%（66mmol/mol）（7.3-9.7%，56-82mmol/mol）。19 岁时，男性（7.9%）和女性（12.7%）的 DKA 年住院率从 6 岁时（男孩 2.0%，女孩 1.4%）稳步上升，达到峰值，然后降至 30 岁时的男性 4.3%和女性 5.4%。在所有 9 岁以上的年龄段，女性的 DKA 患病率均高于男性。
HbA1c 和 DKA 的患病率在青春期内增加，然后下降。作为临床复查标志物的 HbA1c 测量值在青少年晚期急剧下降。需要提供适合年龄的服务来解决这些问题。
