title: National Swedish study of immigrant children with type 1 diabetes showed impaired metabolic control after three years of treatment.
abstract: OBJECTIVE
  This study examined the clinical status and socio-demographic conditions of children with type 1 diabetes at baseline and after three years of treatment, comparing those born to immigrant parents and Swedish parents.
  
  
  METHODS
  This observational nationwide population-based cohort study used prospectively collected registry data from Swediabkids, the National Quality Registry for Paediatric Diabetes in Sweden from 2000 to 2010. Of the 13 415 children with type 1 diabetes, there were 879 born to immigrant parents. We selected three children born to Swedish parents from the same registry for each immigrant child matching them by gender, age and year of diabetes onset (n = 2627; with 10 control children missing probably due to the matching procedure).
  
  
  RESULTS
  Immigrant children had a higher median glycated haemoglobin level (HbA1c) than their Swedish peers, but there was no difference in the frequency of hypoglycaemia or ketoacidosis between the two cohorts. A linear regression model with HbA1c as a dependent variable showed that insulin units per kilogram of body weight were the main reason for inferior metabolic control.
  
  
  CONCLUSIONS
  Children with type 1 diabetes born to immigrant parents had inferior metabolic control three years after disease onset compared to children with Swedish born parents. Social family support and educational coping programmes are needed to improve treatment outcomes in immigrants with diabetes.
authors.affiliation: School of Health and Medical Sciences, Örebro University, Örebro, Sweden.|Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden.|Department of Pediatrics, Mälarsjukhuset Hospital, Eskilstuna, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Söderström
authors.affiliation: Division of Paediatrics, Department of Molecular and Clinical Medicine, Linkoping University, Linköping, Sweden.|Department of Pediatrics, The University Hospital in Linköping, Linköping, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Samuelsson
authors.affiliation: School of Health and Medical Sciences, Örebro University, Örebro, Sweden.|Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Åman
mesh_terms: D002648:Child; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D054242:Emigrants and Immigrants; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D064887:Observational Studies as Topic; D011446:Prospective Studies; D013548:Sweden
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Children; Epidemiology; Immigration; Metabolic control; Type 1 diabetes