Tubiana-Rufi N, Moret L, Chwalow J, Czernichow P
Service de diabétologie pédiatrique, Hôpital Robert-Debré, Paris.
Arch Pediatr. 1994 Nov;1(11):982-90.
A multicenter cross-sectional study was the first step of a project aimed at performing an educational diagnosis for IDDM children in France.
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%).
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).
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.
一项多中心横断面研究是针对法国1型糖尿病（IDDM）儿童进行教育诊断的项目的第一步。
纳入标准为年龄7至13岁、IDDM病程大于6个月且在大学儿科部门接受随访。在六个中心接受随访的173名儿童符合条件。其中165名儿童（年龄10.2±1.9岁，IDDM病程3.1±2.7年）同意参与。家长和儿童完成标准化问卷。进行临床检查，并由儿童的普通糖尿病专科医生完成一份医学问卷。采用单一高效液相色谱法（HPLC）测量糖化血红蛋白（HbA1c）（正常水平±2标准差=4.5%至5.7%）。
平均HbA1c为8.3±1.6%（范围5 - 13.2%），其值分布如下：24.5%的儿童HbA1c≤7%，46.6%的儿童HbA1c≤8%，14%的儿童HbA1c＞10%。年龄（r = 0.33，P＜0.001）、糖尿病病程（r = 0.29，P＜0.001）、生化性低血糖发作次数（r = -0.21，P＜0.01）和胆固醇水平（r = 0.31，P＜0.001）与HbA1c水平相关，且在预测HbA1c时可解释30%的变异。青春期前和青春期儿童的HbA1c水平差异显著（P＜0.02）。其他常见临床参数以及糖尿病监测指标与HbA1c无显著相关性。此外，有四个亚组的平均HbA1c水平出现显著恶化（变化量≥1%）：1）年龄＞10岁（n = 82，P＜0.01）；2）女孩处于青春期阶段（坦纳分期III期与I期相比，P＜小.05）；3）IDDM病程≥2年（n = 106，P＜0.001）；4）母亲非法国本土出生（n = 27，P＜0.001）。
在接受专科护理的这组儿童中，只有50%具有可接受的血糖控制水平（HbA1c≤8%）。确定了与血糖控制相关的因素，以及血糖控制不佳的特定风险儿童亚组，这需要针对性的干预措施。目前正在对该人群进行社会人口学、心理、家庭和认知因素的分析，以便找到血糖控制的其他解释变量并制定针对性的教育项目。
