[Health and factors associated with glycemic control in 165 children with insulin-dependent diabetes, aged 7-23 year].

BACKGROUND

A multicenter cross-sectional study was the first step of a project aimed at performing an educational diagnosis for IDDM children in France.

POPULATION AND METHODS

Inclusion criteria were age 7 to 13 years, IDDM duration > 6 months and to be followed in a university pediatric department. One hundred and seventy-three children, followed in six centers, were eligible. One hundred and sixty-five of them (age 10.2 +/- 1.9 years and IDDM duration 3.1 +/- 2.7 years) agreed to participate. Standardized questionnaires were completed by the parents and children. Clinical examination was performed and a medical questionnaire was completed by the usual diabetologist of children. HbA1c was measured using a single HPLC method (normal levels +/- 2 sd = 4.5 to 5.7%).

RESULTS

Mean HbA1c was 8.3 +/- 1.6% (range 5-13.2%) and values were distributed as follows: < or = 7% for 24.5%, < or = 8% for 46.6% and > 10% for 14% of the children. Age (r = 0.33, P < 0.001), duration of diabetes (r = 0.29, P < 0.001), number of biochemical hypoglycemias (r = -0.21, P < 0.01) and cholesterol level (r = 0.31, P < 0.001) were correlated with HbA1c levels and accounted for 30% of the variance in predicting HbA1c. The difference of HbA1c levels between prepubertal and pubertal children was significant (P < 0.02). Other usual clinical parameters as well as indexes for diabetes monitoring were not significantly correlated with HbA1c. In addition, four subgroups were associated with a significant deterioration (delta > or = 1%) in mean HbA1c levels: 1) age > 10 years (n = 82, P < 0.01); 2) pubertal stage in girls (Tanner stages III vs I, P < 0.05); 3) IDDM duration > or = 2 years (n = 106, P < 0.001); 4) a non French native mother (n = 27, P < 0.001).

CONCLUSIONS

Only 50% of this group under specialized care had an acceptable level of glycemic control (HbA1c < or = 8%). Factors related to glycemic control were identified, as well as subgroups of children at particular risk for bad glycemic control which requires specifically targeted interventions. The analyse of sociodemographic, psychological, familial and cognitive factors is currently being conducted in this population, in order to find other explicative variables of glycemic control and to develop specifically targeted educational programs.