Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong SAR, China.
Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Hong Kong Med J. 2024 Aug;30(4):291-299. doi: 10.12809/hkmj2210552. Epub 2024 Aug 16.
Type 2 diabetes mellitus (T2DM) is becoming increasingly common among children and adolescents worldwide, including those in Hong Kong. This study analysed the characteristics and prevalence of microvascular complications among paediatric T2DM patients in Hong Kong at diagnosis and 2 years after diagnosis.
All patients aged <18 years who had been diagnosed with DM at public hospitals in Hong Kong were recruited into the Hong Kong Childhood Diabetes Registry. Data collected at diagnosis and 2 years after diagnosis were retrospectively retrieved from the Registry for patients diagnosed from 2014 to 2018.
Median haemoglobin A1c (HbA1c) levels were 7.5% (n=203) at diagnosis and 6.5% (n=135) 2 years after diagnosis; 59.3% of patients achieved optimal glycaemic control (HbA1c level <7%) at 2 years. A higher HbA1c level at diagnosis was associated with worse glycaemic control at 2 years (correlation coefficient=0.39; P<0.001). The presence of dyslipidaemia (adjusted odds ratio [aOR]=3.19; P=0.033) and fatty liver (aOR=2.50; P=0.021) at 2 years were associated with suboptimal glycaemic control. Diabetic neuropathy and retinopathy were rare in our cohort, but 18.6% of patients developed microalbuminuria (MA) within 2 years after diagnosis. Patients with MA had a higher HbA1c level at 2 years (median: 7.2% vs 6.4%; P=0.037). Hypertension was a risk factor for MA at 2 years, independent of glycaemic control (aOR=4.61; P=0.008).
These results highlight the importance of early diagnosis and holistic management (including co-morbidity management) for paediatric T2DM patients.
2 型糖尿病（T2DM）在全球范围内，包括香港，越来越常见于儿童和青少年。本研究分析了香港儿科 T2DM 患者在确诊时和确诊后 2 年时微血管并发症的特征和患病率。
所有在香港公立医院确诊为糖尿病的年龄<18 岁的患者均被纳入香港儿童糖尿病登记处。从登记处检索了 2014 年至 2018 年期间确诊的患者在确诊时和确诊后 2 年的数据。
中位血红蛋白 A1c（HbA1c）水平在确诊时为 7.5%（n=203），在确诊后 2 年时为 6.5%（n=135）；2 年后，59.3%的患者达到了理想的血糖控制（HbA1c 水平<7%）。诊断时 HbA1c 水平越高，2 年后血糖控制越差（相关系数=0.39；P<0.001）。2 年后血脂异常（调整后的优势比[aOR]=3.19；P=0.033）和脂肪肝（aOR=2.50；P=0.021）的存在与血糖控制不理想有关。我们的队列中糖尿病神经病变和视网膜病变罕见，但 18.6%的患者在确诊后 2 年内发生微量白蛋白尿（MA）。有 MA 的患者在 2 年内的 HbA1c 水平更高（中位数：7.2%比 6.4%；P=0.037）。高血压是 2 年后 MA 的一个危险因素，独立于血糖控制（aOR=4.61；P=0.008）。
这些结果强调了对儿科 T2DM 患者进行早期诊断和全面管理（包括合并症管理）的重要性。
