HEALTH AND FACTORS ASSOCIATED WITH GLYCEM IC CONTROL IN 165 CHILDREN AGED 7-13 YEARS WITH INSULIN-DEPENDENT DIABETES

Background - A multicenter cross-sectional study was the first step of a project aimed at performing an educational diagnosis for IDDM child ren in France. Population and methods. - Inclusion criteria were age 7 to 13 years, IDDM duration > 6 months and to be followed ill a univer sity pediatric department. One hundred and seventy-three children, fol lowed in six centers, were eligible. One hundred and sixty-five of the m (age 10.2 +/- 1.9 years and IDDM duration 3.1 +/- 2.7 years) agreed to participate. Standardized questionnaires were completed by the pare nts and children. Clinical examination was performed and a medical que stionnaire was completed by the usual diabetologist of children. HbA1c was measured using a single HPLC method (normal levels +/- 2 sd = 4.5 to 5.7%). Results. - Mean HbA1c was 8.3 +/- 1.6% (range 5-13.2%) and values were distributed as follows: less than or equal to 7% for 24.5% , less than or equal to 8% for 46.6% and > 10% for 14% of the children . Age (r = 0.33, P < 0.001), duration of diabetes (r = 0.29, P <0.001) , number of biochemical hypoglycemias (r = - 0.21, P < 0.01) and chole sterol level (r = 0.31, P < 0.001) were correlated with HbA1c levels a nd accounted for 30% of the variance in predicting HbA1c. The differen ce of HbA1c levels between prepubertal and pubertal children was signi ficant (P < 0.02). Other usual clinical parameters as well as indexes for diabetes monitoring were not significantly correlated with HbA1c. In addition, four subgroups were associated with a significant deterio ration (Delta greater than or equal to 1%) in mean HbA1c levels: I) ag e > 10 years (n = 82, P < 0.01); 2) pubertal stage in girls (Tanner st ages III vs I, P < 0.05); 3) IDDM duration greater than or equal to 2 years (n = 106, P < 0.001); 4) a non French native mother (n = 27, P < 0.001). Conclusions. - Only 50% of this group under specialized care had an acceptable level of glycemic control (HbA1c less than or equal to 8%). Factors related to glycemic control were identified, as well a s subgroups of children at particular risk for bad glycemic control wh ich requires specifically targeted interventions. The analyse of socio demographic, psychological, familial and cognitive factors is currentl y being conducted in this population, in order to find other explicati ve variables of glycemic control and to develop-specifically targeted educational programs.