Child Opportunity Index and clinical characteristics at diabetes diagnosis in youth: type 1 diabetes versus type 2 diabetes.
Child Opportunity Index and clinical characteristics at diabetes diagnosis in youth: type 1 diabetes versus type 2 diabetes.
复制标题
儿童机会指数和青少年糖尿病诊断的临床特征：1 型糖尿病与 2 型糖尿病。
DOI：
10.1136/bmjdrc-2023-003968
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发表时间：
2024
影响因子：
4.1
通讯作者：
Vajravelu,MaryEllen
中科院分区：
文献类型：
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作者：
Hoyek,Kim;Libman,Ingrid;Mkparu,Nkeiruka;Hong,YongHee;Arslanian,Silva;Vajravelu,MaryEllen
在青少年1型糖尿病（T1D）患者中，纵向血糖控制不良与社区水平的不利社会经济条件有关。儿童机会指数（COI）包括教育、健康、环境、社会和经济因素，与青少年肥胖有关，但尚未对新发T1D或2型糖尿病（T2D）的青少年进行评估。我们假设较低的COI与糖尿病诊断的不良临床结果有关，并且由于不同的危险因素和病理生理学，新发T2D的青年COI比T1D的青年低。研究设计与方法回顾性分析某大型学术儿科医院收治的新发青少年糖尿病患者。采用t检验和Χ2tests比较不同糖尿病类型的COI。采用多变量线性和逻辑回归分析来评估COI与临床特征之间的关系，并按糖尿病类型分层，并根据年龄和性别进行调整。结果该队列（n=484）因糖尿病类型而存在种族和年龄差异（T1D: n=389；黑人10.0%，白人81.2%；年龄9.6±0.2岁；T2D: n=95；黑人44.2%，白人48.4%；年龄14.8±0.3岁）。青年T2D患者COI较低（p<0.001）。低COI与T1D和T2D的糖尿病酮症酸中毒有关。低COI的黑人青年在T2D青年中糖化血红蛋白最高，在T1D青年中肥胖患病率最高。结论青年发病T1D和T2D的scoi与诊断时的不同特征相关，但总体而言，青年发病T2D的scoi更差。这些发现强调了在设计干预措施以降低T2D风险和改善青少年糖尿病诊断结果时需要解决社会经济逆境。
IntroductionAmong youth with type 1 diabetes (T1D), longitudinal poor glycemic control is associated with adverse socioeconomic conditions at the neighborhood level. Child Opportunity Index (COI), which encompasses measures of education, health, environment, social, and economic factors, is associated with obesity in youth but has not been evaluated in youth with new-onset T1D or type 2 diabetes (T2D). We hypothesized that lower COI would be associated with adverse clinical outcomes at diabetes diagnosis, and due to differing risk factors and pathophysiology, that youth with new-onset T2D would have lower COI than youth with T1D.Research design and methodsRetrospective cohort of youth with new-onset diabetes admitted to a large academic pediatric hospital. COI was compared by diabetes type using t-tests and Χ2tests. Multivariable linear and logistic regression analyses were used to evaluate associations between COI and clinical characteristics, stratified by diabetes type and adjusted for age and sex.ResultsThe cohort (n=484) differed in race and age by diabetes type (T1D: n=389; 10.0% black, 81.2% white; age 9.6±0.2 years; T2D: n=95; 44.2% black, 48.4% white; age 14.8±0.3 years). Youth with T2D had lower COI (p<0.001). Low COI was associated with diabetic ketoacidosis in T1D and T2D. Black youth with low COI had the highest hemoglobin A1c among youth with T2D and the highest obesity prevalence among youth with T1D.ConclusionsCOI is associated with differing characteristics at diagnosis in youth-onset T1D and T2D but is worse among youth with T2D overall. These findings underscore the need to address socioeconomic adversity when designing interventions to reduce T2D risk and to improve outcomes at diabetes diagnosis in youth.