Predictors of glucose control in children and adolescents with type 1 diabetes mellitus.
OBJECTIVE
To evaluate the glucose control [(as measured by hemoglobin A1c (HbA1c)], the factors associated with glycemic control, and possible explanations for these associations in a sample of children and adolescents with type 1 diabetes.


METHODS
Data were collected on 155 children and adolescents, with type 1 diabetes mellitus, attending a multidisciplinary diabetes clinic in Portland, OR. Patients' hospital charts were reviewed to determine demographic factors, disease-related characteristics, and HbA1c level.


RESULTS
Mean percent HbA1c was 9.3. Adolescents between the ages of 14 and 18 yr were in poorer metabolic control (adjusted mean percent HbA1c 0.56 higher than children 2-8 yr). Children who attended the clinic three to four times in the previous year were in better control (adjusted mean percent HbA1c 0.46 lower than those who visited two or fewer times and 1.11 lower than those who attended five or more times). Children with married parents were in better glycemic control than those of single, separated, or divorced parents (adjusted mean percent HbA1c 0.47 lower for children of married parents). This effect appeared to be mediated, in part, by the number of glucose checks performed per day.


CONCLUSIONS
This study suggests that adolescents should be targeted for improved metabolic control. Diabetes team members need to be aware of changing family situations and provide extra support during stressful times. Regular clinic attendance is an important component of intensive diabetes management. Strategies must be developed to improve accessibility to the clinic and to identify patients who frequently miss appointments.
Urbach
Stacey L
SL
Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR, USA. stacey.urbach@sickkids.ca
LaFranchi
Stephen
S
Lambert
Lori
L
Lapidus
Jodi A
JA
Daneman
Denis
D
Becker
Thomas M
TM
D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test / Q000379:methods; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies
D001786:Blood Glucose