Metabolic control as reflectet by HbA1c in children, adolescents and young adults with type-1 diabetes mellitus:: combined longitudinal analysis including 27,035 patients from 207 centers in Germany and Austria during the last decade
Metabolic control as reflectet by HbA1c in children, adolescents and young adults with type-1 diabetes mellitus:: combined longitudinal analysis including 27,035 patients from 207 centers in Germany and Austria during the last decade
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DOI：
10.1007/s00431-007-0586-9
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发表时间：
2008-04-01
影响因子：
3.6
通讯作者：
Holl, R. W.
中科院分区：
文献类型：
--
作者：
Gerstl, E. -M.;Rabl, W.;Holl, R. W.
简介 虽然 HbA1c 水平在预测 1 型糖尿病患者微血管和大血管并发症方面的核心作用已被普遍接受；当前指南中的建议与常规护理期间实际达到的代谢控制水平存在很大差异。关于影响儿科年龄组以及从儿科糖尿病护理过渡到成人糖尿病护理期间代谢控制的因素的信息有限。在一个大型前瞻性多中心数据库 (DPV-Wiss) 中，1995 年至 2005 年间记录了 27,035 名 1 型糖尿病患者（94,074 个观察年）的 338,330 次个人 HbA1c 测量结果。数据从 207 个机构匿名传输。 HbA1c 值在数学上标准化为 DCCT 正常范围 (4.05-6.05%)。使用SAS 9.1软件使用非参数统计进行统计分析。所有测量值的中位 HbA1c 为 7.8%，糖尿病病程的影响很大：发病时的中位 HbA1c 为 9.1%，在糖尿病的前 2 年中为 7.1%，随后在缓解期过后的患者中增加至 7.9%（> 2 年，20,314 名患者）；存在很强的年龄依赖性。 23% 的人发现 HbA1c 高于推荐指南。对于所有年龄组，女孩/女性的 HbA1c 值均高于男孩（平均差异 0.1%，p < 0.0001）。季节性变化非常小，9 月 HbA1c 值最低（平均值：7.86%），1 月最高值（8.08%；p < 0.0001）。比较三个时期：1995-1997 年、1998-2000 年和 2001-2005 年，观察到 HbA1c 有所改善；缓解后，HbA1c 中位数从 8.5% 降至 7.6%。在多变量模型中，检测到年龄 (p < 0001)、糖尿病病程 (p < 0.0001)、性别 (p < 0.02)、少数民族身份 (p < 0.0001)、季节 (p < 0.0001)、治疗周期 (p < 0.0001)、胰岛素治疗 (p < 0.0001) 和中心效应 (p < 0.0001) 对 HbA1c 具有显着影响。 0.0001).结论与患者相关和 治疗相关变量对儿童和年轻 T1DM 患者的代谢控制有很大影响。与普遍的看法相反，夏季的代谢控制仅比冬季稍好一些。在过去 10 年中观察到代谢控制有所改善。
Introduction While the central role of HbA1c levels for the prediction of micro- and macrovascular complications in patients with type 1 diabetes is generally accepted; recommendations in current guidelines and the level of metabolic control actually achieved during routine care differ widely. Limited information is available on factors that influence metabolic control in the pediatric age group and during the transition from pediatric to adult diabetes care. In a large prospective multicenter database (DPV-Wiss), 338,330 individual HbA1c measurements from 27,035 patients with type-1 diabetes (94,074 observation years) were recorded between 1995 and 2005. Data were anonymously transmitted from 207 institutions. HbA1c values were mathematically standardized to the DCCT normal range (4.05-6.05%). The SAS 9.1 software was used for statistical analysis using nonparametric statistics. Median HbA1c for all measurements was 7.8%, with a strong effect of diabetes duration: median HbA1c at onset was 9.1%, during the first 2 years of diabetes 7.1% with a subsequent increase to 7.9% in patients beyond the remission phase (> 2 years, 20,314 patients); a strong age dependency was present. HbA1c above the recommended guidelines was found in 23%. For all age groups, girls/women had higher HbA1c values compared to boys (mean difference 0.1%, p < 0.0001). Seasonal variation was remarkably small with the lowest HbA1c values in September (mean: 7.86%) and highest values in January (8.08%; p < 0.0001). Some improvement in HbA1c was observed comparing three periods: 1995-1997, 1998-2000 and 2001-2005; after remission the median HbA1c decreases from 8.5% to 7.6%. In a multivariate model, a significant influence on HbA1c was detected for age (p < 0001), duration of diabetes (p < 0.0001), gender (p < 0.02), minority status (p < 0.0001), season (p < 0.0001), treatment period (p < 0.0001), insulin therapy (p < 0.0001) and center effect (p < 0.0001).Conclusions Both patient-related and treatment-related variables have a strong influence on metabolic control achieved in pediatric and young adult patients with T1DM. In contrast to wide-spread belief, metabolic control is only marginally better in summer compared to winter. Some improvement in metabolic control was observed during the last 10 years.