Most Children With Type 1 Diabetes Can Achieve Good Glycemic Control

In clinical practice, more than two-thirds of children with type 1 diabetes who receive intensive treatment are able to attain glycemic targets. Low socioeconomic status (SES), but not race/ethnicity, is associated with poor metabolic control.

"The findings of the DCCT have revolutionized treatment of type 1 diabetes by demonstrating the importance of lowering the glucose and glycosylated hemoglobin (HbA1c) level to as close to normal as possible," Dr. Stuart A. Weinzimer and colleagues from Yale University School of Medicine, New Haven, Connecticut, write.

"Previous studies that examined demographic and psychological factors in attempts to delineate specific populations or characteristics that contribute to poor metabolic control in youth with diabetes have often provided conflicting results," they note.
The researchers examined factors that might interfere with optimal glycemic control in children and adolescents with type 1 diabetes in the context of an intensive treatment program. A database review was conducted of all patients under age 18 years with type 1 diabetes for at least 6 months duration in the Yale Pediatric Diabetes Program.

A total of 455 diabetic children were included in the study. Their mean age was 11.8 years, and they had had diabetes for a mean duration of 4.9 years. More than 60% of the patients were using pump therapy.

The mean HbA1c level for the cohort was 7.6%. Overall, 31% of the subjects failed to meet the therapeutic goal of 8.0%.
Results of multiple linear regression analysis revealed significant associations between higher HbA1c levels and female sex, older age, longer duration of diabetes, injection therapy, and lower SES.

Approximately 82% of the group was Caucasian, 8% African American, and 10% Hispanic. After controlling for SES, race/ethnicity was not a significant determinant of HbA1c level.

"Even our low-income families achieved a degree of metabolic control of diabetes that compared well with international standards and is similar to the HbA1c levels achieved in intensively treated adolescents in the DCCT," Dr. Weinzimer and colleagues report.

"On the other hand, there remains a small core of patients with multiple risk factors who continue to do very poorly," they note. "New strategies are needed to help these patients achieve better control of their diabetes."
J Pediatr 2006;149:227-232.

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