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Factors affecting glycosylated hemoglobin values in children with insulin-dependent diabetes
Insights
Metabolic control in children with insulin-dependent diabetes (IDD) is closely linked to age, especially in girls, not disease duration. Conventional treatments show limited short-term improvement in GHb levels, suggesting a need for targeted interventions.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Diabetes Management
Background:
- Insulin-dependent diabetes (IDD) management in children requires continuous monitoring of metabolic control.
- Glycated hemoglobin (GHb) and blood glucose levels are key indicators of long-term and short-term glycemic control, respectively.
Purpose of the Study:
- To evaluate metabolic control in children with IDD using conventional treatment methods.
- To assess the influence of patient's age, sex, and disease duration on metabolic control.
- To identify specific subgroups of children who may benefit from more aggressive therapeutic approaches.
Main Methods:
- A cohort of 477 children with IDD were monitored over 18 months.
- Measurements included glycated hemoglobin (GHb) and random blood glucose concentrations.
- Data analysis considered age, sex, disease duration, and, in a subgroup, insulin dosage and injection frequency.
Main Results:
- Mean GHb was 11.8% and mean blood glucose was 237 mg/dl; only 1.4% had normal GHb.
- Significant correlation found between GHb and age/blood glucose, but not disease duration >1 year.
- Correlation with age was specific to girls; GHb changes over time were limited, with 40.5% showing <1% change.
Conclusions:
- Metabolic control in pediatric IDD is more strongly related to the child's age, particularly in females, than to disease duration.
- Conventional therapeutic methods demonstrate limited short-term efficacy in improving GHb levels.
- Adolescent girls with IDD may require more aggressive treatment strategies for better metabolic control.
Abstract:
In 477 children with IDD treated by conventional methods, GHb (microcolumn chromatography) and a simultaneous random blood glucose concentration were measured over an 18-month period as indicators of metabolic control (once in 61 children, twice in 99, three or more times in 317). The data were analyzed to assess the effects of patient's age, sex, disease duration, and, in a random subgroup of 273, the number of daily insulin injections and insulin dose (U/kg). The mean +/- SEM percent GHb over this period was 11.8 +/- 0.2% and blood glucose concentration 237 +/- 9 mg/dl. Only seven children (1.4%) had a normal GHb value. There was a highly significant correlation between GHb and both age and blood glucose concentration but not with disease duration greater than one year. The correlation with age was present only in the girls. In 416 children evaluated more than once, with a mean duration between initial and most recent evaluations of 11.3 months, GHb remained within +/- 1% of the initial value in 40.5%, decreased in 32.3%, and increased in 24.2%. These data indicate a closer relationship between metabolic control in children with IDD and age of the child, particularly in females, than with disease duration. In our clinic, using conventional therapeutic methods, the ability to improve control over the short term as measured by changes in percent GHb has been quite limited. This study helps to target those IDD children, especially adolescent girls, requiring a more aggressive therapeutic approach.