A contrast between children and adolescents with excellent and poor control: the T1D exchange clinic registry experience
A contrast between children and adolescents with excellent and poor control: the T1D exchange clinic registry experience
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DOI：
10.1111/pedi.12067
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发表时间：
2014-03-01
影响因子：
3.4
通讯作者：
Haller, Michael J.
中科院分区：
文献类型：
--
作者：
Campbell, Meredith S.;Schatz, Desmond A.;Haller, Michael J.
目的：优化儿童1型糖尿病（T1D）的血糖控制对降低并发症的长期风险至关重要。我们使用来自58家美国糖尿病诊所的T1D Exchange数据库来确定血糖控制良好和血糖控制不良的儿童糖尿病管理特征的差异。方法6-17岁糖尿病患者病程>= 2年，对照良好者[(A1c = 9%)(75 mmol/mol) (N = 2684)]采用logistic回归。结果优对照组和差对照组在糖尿病管理方面存在显著差异（均p < 0.001），优对照组更多使用胰岛素泵，进行血糖监测>= 5x/d，少给药，饭前给药而不是餐中或餐后给药，使用特定餐胰岛素：碳水化合物比例，在用餐前检查血糖，在白天零食时给胰岛素，给更多的胰岛素。使用较低的平均每日总胰岛素剂量。在调整了人口统计学和社会经济因素后，糖尿病管理特征仍然与控制的好坏密切相关。值得注意的是，两组之间发生严重低血糖的频率相似，而DKA在控制不良组中更为常见。结论血糖控制良好的儿童与血糖控制不佳的儿童在糖尿病自我管理方面表现出明显不同。这一知识可以进一步告知糖尿病护理人员和患者可以增强的特定特征和行为，以潜在地改善血糖控制。
ObjectivesOptimizing glycemic control in pediatric type 1 diabetes (T1D) is essential to minimizing long-term risk of complications. We used the T1D Exchange database from 58 US diabetes clinics to identify differences in diabetes management characteristics among children categorized as having excellent vs. poor glycemic control.MethodsAmong registry participants 6-17 yr old with diabetes duration >= 2 yr, those with excellent control [(A1c = 9% )(75 mmol/mol) (N = 2684)] using logistic regression.ResultsThe excellent and poor control groups differed substantially in diabetes management (p < 0.001 for all) with more of the excellent control group using insulin pumps, performing blood glucose monitoring >= 5x/d, missing fewer boluses, bolusing before meals rather than at the time of or after a meal, using meal-specific insulin:carbohydrate ratios, checking their blood glucose prior to giving meal time insulin, giving insulin for daytime snacks, giving more bolus insulin, and using a lower mean total daily insulin dose than those in poor control. After adjusting for demographic and socioeconomic factors, diabetes management characteristics were still strongly associated with good vs. poor control. Notably, frequency of severe hypoglycemia was similar between the groups while DKA was more common in the poorly controlled group.ConclusionsChildren with excellent glycemic control tend to exhibit markedly different diabetes self-management techniques than those with poor control. This knowledge may further inform diabetes care providers and patients about specific characteristics and behaviors that can be augmented to potentially improve glycemic control.