Clinical and psychological course of diabetes from adolescence to young adulthood - A longitudinal cohort study
Clinical and psychological course of diabetes from adolescence to young adulthood - A longitudinal cohort study
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DOI：
10.2337/diacare.24.9.1536
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发表时间：
2001-09-01
期刊：
影响因子：
16.2
通讯作者：
Dunger, DB
中科院分区：
文献类型：
--
作者：
Bryden, KS;Peveler, RC;Dunger, DB
目的：了解糖尿病在青少年期的临床和心理病程，以及与青年期血糖控制的关系。研究设计和方法：一项纵向队列研究，从儿科糖尿病门诊登记的青少年中招募。共有76名11-18岁的个体（43名男性患者，33名女性患者）完成了基线评估，65名个体（86%）在年轻成人（20-28岁）时重新进行了评估。对血糖控制（HbA(1c)）、体重增加（BMI）和并发症的发生进行纵向评估。青少年完成了自我报告问卷，以评估情绪和行为问题以及自尊。青年人的心理状态通过修订的临床访谈表和自我报告的简短症状量表进行评估。结果：平均HbA（1c）水平在青春期晚期达到峰值，女性参与者的水平更差（18-19岁时平均为11.1%）。8年间，女性患者BMI指数（BMI bb0）为25.0 kg/m(2)以上的个体比例从21%增加到54%，男性患者从2%增加到28%。严重的糖尿病相关事件包括1例患者死亡和2例患者认知障碍。糖尿病并发症患者（25%的男性患者和38%的女性患者）的平均HbA（1c）水平显著高于无并发症患者（差异为1.9%,95% CI 1.1-2.7, P < 0.0001）。基线时的行为问题与随后8年较高的平均HbA（1c）相关（β = 0.15, SEM (β) 0.04, P < 0.001, 95% Cl 0.07-0.24）。结论：该队列的结果普遍较差。青少年时期的行为问题似乎对以后的血糖控制有重要影响。
OBJECTIVE - To determine the clinical and psychological course of diabetes through adolescence and the relationship with glycemic control in young adulthood.RESEARCH DESIGN AND METHODS - A longitudinal cohort study of adolescents recruited from the register of the outpatient pediatric diabetes clinic. A total of 76 individuals (43 mate patients, 33 female patients) aged 11-18 years completed baseline assessments, and 65 individuals (86%) were reinter-dewed as young adults (20-28 years of age). Longitudinal assessments were made of glycemic control (HbA(1c)), weight gain (BMI), and development of complications. Adolescents completed sell-report questionnaires to assess emotional and behavioral problems as well as self-esteem. As young adults, psychological state was assessed by the Revised Clinical Interview Schedule and the self-report Brief Symptom Inventory.RESULTS - Mean HbA(1c) levels peaked in late adolescence and were worse in female participants (average 11.1% at 18-19 years of age). The proportion of individuals who were over",eight (BMI > 25.0 kg/m(2)) increased during the 8-year period from 21 to 54% in female patients and from 2 to 28% in male patients. Serious diabetes-related events included death in one patient and cognitive impairment in two patients. Individuals in whom diabetic complications developed (25% of male patients and 38% of female patients) had significantly higher mean HbA(1c) levels than those without complications (difference 1.9%, 95% CI 1.1-2.7, P < 0.0001). Behavioral problems at baseline were related to higher mean HbA(1c) during the subsequent 8 years (beta = 0.15, SEM (beta) 0.04, P < 0.001, 95% Cl 0.07-0.24).CONCLUSIONS - The outcome for this cohort was generally poor. Behavioral problems in adolescence seem to be important in influencing later glycemic control.