Contrasting the clinical care and outcomes of 2,622 children with type 1 diabetes less than 6 years of age in the United States T1D Exchange and German/Austrian DPV registries
Contrasting the clinical care and outcomes of 2,622 children with type 1 diabetes less than 6 years of age in the United States T1D Exchange and German/Austrian DPV registries
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DOI：
10.1007/s00125-014-3272-2
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发表时间：
2014-08-01
期刊：
影响因子：
8.2
通讯作者：
Holl, Reinhard W.
中科院分区：
文献类型：
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作者：
Maahs, David M.;Hermann, Julia M.;Holl, Reinhard W.
目的/假设本研究旨在比较6岁以下注册参与者的参与者特征、治疗方式和临床结果。方法参与者特征、治疗方式和临床结果(糖化血红蛋白(1c)、严重低血糖[SH]和糖尿病酮症酸中毒[DKA])，以及达到国际儿童和青少年糖尿病学会(<；7.5%[<；58 mmol/mol])和ADA(<；8.5%[<；结果糖尿病患者胰岛素泵使用频率(74%vs50%，p<；0.001)和糖化血红蛋白(1c)水平低于T1D交换(T1DX)(平均7.4%vs8.2%，p<；0.001)。与泵使用者(P<；0.001)和注射使用者(P<；0.001)的T1DX相比，DPV的HbA(1c)水平较低。与T1DX儿童(HbA(1c)<；7.5%：56%vs22%，p<；0.001；HbA(1c)<；8.5%：90%vs66%，p<；0.001)相比，患有DPV的儿童更多地达到了推荐的HbA(1c)目标。调整后的HbA(1c)水平为7.5%或8.5%的DPV分别比T1DX高4.2%(p<；0.001)和3.6%(p<；0.001)。HbA(1c)的频率在不同的登记处或HBA(1c)之间没有差异，而DKA的频率在T1DX中较高，且在HBA(1c)水平较高的儿童中更高。结论/解释DPV数据表明，6岁以下的1型糖尿病儿童的HBA(1c)经常达到<；7.5%。在年轻患者中改善1型糖尿病的代谢控制似乎可以在不增加SH的情况下降低DKA的风险。与DPV组相比，T1DX组年轻患者的不良控制频率更高，这并不能完全用较少使用胰岛素泵来解释，可能与美国推荐给这个年龄段的较高的HBA(1c)目标有关。
AIMS/hypothesis The study aimed to compare participant characteristics, treatment modalities and clinical outcomes in registry participants less than 6 years old.Methods Participant characteristics, treatment modalities and clinical outcomes (HbA(1c), severe hypoglycaemia [SH] and diabetic ketoacidosis [DKA]) as well as frequencies of attaining HbA(1c) goals in line with the International Society for Pediatric and Adolescent Diabetes (< 7.5% [< 58 mmol/mol]) and ADA (< 8.5% [< 69 mmol/mol]) were compared.Results Insulin pump use was more frequent (74% vs 50%, p < 0.001) and HbA(1c) levels lower in the Prospective Diabetes Follow-up Registry (DPV) than in the T1D Exchange (T1DX) (mean 7.4% vs 8.2%, p < 0.001). A lower HbA(1c) level was seen in the DPV compared with the T1DX for both pump users (p < 0.001) and injection users (p < 0.001). More children from DPV were meeting the recommended HbA(1c) goals, compared with children from T1DX (HbA(1c) < 7.5%: 56% vs 22%, p < 0.001; HbA(1c) < 8.5%: 90% vs 66%, p < 0.001). The adjusted odds of having an HbA(1c) level < 7.5% or < 8.5% were 4.2 (p < 0.001) and 3.6 (p < 0.001) higher for the DPV than the T1DX, respectively. The frequency of SH did not differ between registries or by HbA(1c), whereas the frequency of DKA was higher for the T1DX and greater in those with higher HbA(1c) levels.Conclusions/interpretation DPV data indicate that an HbA(1c) of < 7.5% can frequently be achieved in children with type 1 diabetes who are under 6 years old. An improved metabolic control of type 1 diabetes in young patients appears to decrease the risk of DKA without increasing SH. The greater frequency of suboptimal control in young patients in the T1DX compared with the DPV is not fully explained by a less frequent use of insulin pumps and may relate to the higher HbA(1c) targets that are recommended for this age group in the USA.