Stępniewska Anna, Szczudlik Ewa, Drożdż Dorota, Nazim Joanna, Starzyk Jerzy, Januś Dominika, Wójcik Małgorzata
Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, 30-663 Cracow, Poland.
Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, 30-663 Cracow, Poland.
J Clin Med. 2025 Jul 3;14(13):4704. doi: 10.3390/jcm14134704.
: Type 1 diabetes (T1D) in children is associated with increased cardiovascular risk, partly due to coexisting blood pressure (BP) disturbances. Ambulatory blood pressure monitoring (ABPM) is recommended for detecting subtle BP abnormalities, yet the relationship between glycemic control, T1D duration, and specific BP disturbances remains unclear. This study evaluated associations between HbA1c levels, T1D duration, and ABPM-derived BP parameters in a pediatric population with T1D. : We included 357 children and adolescents (aged 7-18.8 years) with T1D treated at a tertiary center. All participants underwent 24 h ABPM. Glycemic control was assessed using HbA1c; values > 6.5% were considered suboptimal. We analyzed associations between HbA1c, T1D duration, and various BP parameters, including daytime and nighttime systolic and diastolic BP, nocturnal dipping, and hypertension defined by ABPM criteria. Logistic regression analyses were performed to identify independent predictors of elevated HbA1c. : Arterial hypertension was confirmed in 10% of patients, and 41% showed a non-dipping BP profile. There were no significant differences in HbA1c or T1D duration between dippers and non-dippers. However, patients with HbA1c > 6.5% had significantly higher 24 h diastolic BP and were more likely to meet hypertension criteria ( = 0.009). In univariate regression, both longer T1D duration (OR = 1.086; = 0.033) and higher 24 h diastolic BP (OR = 1.065; = 0.0068) were associated with elevated HbA1c. Both remained significant in multivariate analysis. : Impaired glycemic control in children and adolescents with T1D was independently associated with higher 24 h diastolic BP and longer diabetes duration.
儿童1型糖尿病（T1D）与心血管风险增加有关，部分原因是并存的血压（BP）紊乱。推荐采用动态血压监测（ABPM）来检测细微的血压异常，但血糖控制、T1D病程与特定血压紊乱之间的关系仍不明确。本研究评估了T1D儿童人群中糖化血红蛋白（HbA1c）水平、T1D病程与ABPM得出的血压参数之间的关联。
我们纳入了在一家三级中心接受治疗的357例患有T1D 的儿童和青少年（年龄7 - 18.8岁） 。所有参与者均接受了24小时ABPM。使用HbA1c评估血糖控制情况；HbA1c值>6.5%被认为是控制不佳。我们分析了HbA1c、T1D病程与各种血压参数之间的关联，包括日间和夜间收缩压和舒张压、夜间血压下降情况以及根据ABPM标准定义的高血压。进行逻辑回归分析以确定HbA1c升高的独立预测因素。
10%的患者被确诊为动脉高血压，41%表现为非勺型血压模式。勺型血压者和非勺型血压者的HbA1c或T1D病程无显著差异。然而HbA1c>6.5%的患者24小时舒张压显著更高，且更有可能达到高血压标准（P = 0.009） 。在单变量回归中T1D病程较长（比值比[OR]=1.086；P = 0.033）和24小时舒张压较高（OR = 1.065；P = 0.0068）均与HbA1c升高有关。两者在多变量分析中均保持显著。
T1D儿童和青少年血糖控制受损与24小时舒张压较高和糖尿病病程较长独立相关。
