Rosilio M, Cotton J B, Wieliczko M C, Gendrault B, Carel J C, Couvaras O, Ser N, Gillet P, Soskin S, Garandeau P, Stuckens C, Le Luyer B, Jos J, Bony-Trifunovic H, Bertrand A M, Leturcq F, Lafuma A, Bougnères P F
Hôpital Saint Vincent de Paul, Service d'Endocrinologie, Paris, France.
Diabetes Care. 1998 Jul;21(7):1146-53. doi: 10.2337/diacare.21.7.1146.
To determine on a large scale the multiple medical and nonmedical factors that influence glycemic control in the general population of children with diabetes, we performed a nationwide French cross-sectional study.
We enrolled 2,579 patients aged 1-19 years with type 1 diabetes of > 1 year's duration. The study was center based: 270 centers were identified, 206 agreed to participate, and 147 included at least 90% of their patients. Questionnaires were completed by physicians interviewing patients and family, and HbA1c measurements were centralized. To identify explanatory variables for HbA1c level and frequency of severe hypoglycemia, we performed multiple regression analysis using all the quantitative variables collected and stepwise logistic regression for the qualitative variables.
Mean HbA1c value for the whole population was 8.97 +/- 1.98% (normal 4.7 +/- 0.7% [SD]). Only 19 children (0.7%) had ketoacidosis during the 6 months before the study, whereas 593 severe hypoglycemia events occurred in 338 children (13.8%). Control was better in university-affiliated hospitals and centers following > 50 patients, reflecting the importance of access to experienced diabetologists. Children had a mean of 2.3 injections, allegedly performed 2.8 glucose measurements per day, and were seen an average of 4.6 times per year at the center. In the multiple regression analysis, 94% of the variance of HbA1c was explained by our pool of selected variables, with the highest regression coefficient between HbA1c and age (Rc = 0.43, P < 0.0001), then with daily insulin dosage per kilogram (Rc = 0.28, P < 0.0001), mother's age (Rc = 0.26, P < 0.0001), frequency of glucose measurements (Rc = 0.21, P < 0.0001), and diabetes duration (Rc = 0.14, P < 0.0001). Logistic regression identified quality of family support and dietary compliance, two related qualitative and possibly subjective variables, as additional explanatory determinants of HbA1c. The frequency of severe hypoglycemia was 45 per 100 patient-years and correlated with diabetes duration, but not with HbA1c levels or other variables.
Although overall results remain unsatisfactory, 33% of studied French children with type 1 diabetes had HbA1c < 8%, the value obtained in Diabetes Control and Complications Trial adolescents treated intensively. Diabetes management in specialized centers should be encouraged.
为大规模确定影响普通糖尿病儿童群体血糖控制的多种医学和非医学因素，我们开展了一项全国性的法国横断面研究。
我们纳入了2579例1至19岁、病程超过1年的1型糖尿病患者。该研究以中心为基础：确定了270个中心，206个同意参与，147个中心纳入了至少90%的患者。问卷由医生通过询问患者及其家属来完成，糖化血红蛋白（HbA1c）测量进行集中处理。为确定HbA1c水平和严重低血糖发生频率的解释变量，我们对收集的所有定量变量进行多元回归分析，对定性变量进行逐步逻辑回归分析。
总体人群的平均HbA1c值为8.97±1.98%（正常为4.7±0.7%[标准差]）。在研究前6个月，只有19名儿童（0.7%）发生了酮症酸中毒，而338名儿童（13.8%）发生了593次严重低血糖事件。在收治超过50例患者的大学附属医院和中心，血糖控制情况更好，这反映了获得经验丰富的糖尿病专家的重要性。儿童平均每天注射2.3次，据称每天进行2.8次血糖测量，每年到中心就诊平均4.6次。在多元回归分析中，我们所选变量组解释了HbA1c变异的94%，HbA1c与年龄之间的回归系数最高（Rc = 0.43，P < 0.0001），其次是每千克体重的每日胰岛素剂量（Rc = 0.28，P < 0.0001）、母亲年龄（Rc = 0.26，P < 0.0001）、血糖测量频率（Rc = 0.21，P < 0.0001）和糖尿病病程（Rc = 0.14，P < 0.0001）。逻辑回归确定家庭支持质量和饮食依从性这两个相关的定性且可能主观的变量为HbA1c的额外解释性决定因素。严重低血糖的发生频率为每100患者年45次，与糖尿病病程相关，但与HbA1c水平或其他变量无关。
尽管总体结果仍不尽人意，但在接受研究的法国1型糖尿病儿童中，33%的患者HbA1c < 8%，这是在糖尿病控制与并发症试验中接受强化治疗的青少年所达到的值。应鼓励在专科中心进行糖尿病管理。
