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Original Articles

Factors Associated With Glycemic Control: A cross-sectional nationwide study in 2,579 French children with type 1 diabetes

  1. Myriam Rosilio, MD,
  2. Jean-BenoîT Cotton, MD,
  3. Marie-Claire Wieliczko, MD,
  4. Bénédicte Gendrault, MD,
  5. Jean-Claude Carel, MD,
  6. Olga Couvaras, MD,
  7. Nicole Ser, MD,
  8. Pierre Gillet, MD,
  9. Sylvie Soskin, MD,
  10. Patrick Garandeau, MD,
  11. Chantal Stuckens, MD,
  12. Bernard Le Luyer, MD,
  13. Joseph Jos, MD,
  14. Hélène Bony-Trifunovic, MD,
  15. Anne-Marie Bertrand, MD,
  16. France Leturcq, PHD,
  17. Antoine Lafuma, PHD,
  18. The French Pediatric Diabetes Group and
  19. Pierre-François Bougnères, MD
  1. Hôpital Saint Vincent de Paul, Service d'Endocrinologie et U342 INSERM Paris, France
  2. Centre Hospitalier Valence, France
  3. Hôpital Charles Nicolle Rouen, France
  4. Hôpital d'Enfants Vandoeuvre-les-Nancy, France
  5. Centre Hospitalier Régional Purpan Toulouse, France
  6. Clinique de l'Union Vaulx-en-Velin, France
  7. Centre Hospitalier Universitaire Hautepierre Strasbourg, France
  8. Institut Saint-Pierre Palavas-les-Flots, France
  9. Hôpital Calmette Lille, France
  10. Centre Hospitalier Le Havre, France
  11. Hôpital Necker Paris, France
  12. Centre Hospitalier Nord Amiens, France
  13. Centre Hospitalier Universitaire Saint-Jacques Besançon, France
  14. CEMKA Bourg-la-Reine, France
  1. Address correspondence and reprint requests to P.F. Bougnères, MD, Hôpital Saint Vincent de Paul, Service d'Endocrinologie Pédiatrique, 82, avenue Denfert Rochereau, 75014 Paris, France. E-mail: pierre.bougneres{at}svp.ap-hop-paris.fr
Diabetes Care 1998 Jul; 21(7): 1146-1153. https://doi.org/10.2337/diacare.21.7.1146
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Abstract

OBJECTIVE To determine on a large scale the multiple medical and nonmedical factors that influence glycemic control in the general population of children with diabetes, we performed a nationwide French cross-sectional study.

RESEARCH DESIGN AND METHODS We enrolled 2,579 patients aged 1–19 years with type 1 diabetes of > 1 year's duration. The study was center based: 270 centers were identified, 206 agreed to participate, and 147 included at least 90% of their patients. Questionnaires were completed by physicians interviewing patients and family, and HbA1c measurements were centralized. To identify explanatory variables for HbA1c level and frequency of severe hypoglycemia, we performed multiple regression analysis using all the quantitative variables collected and stepwise logistic regression for the qualitative variables.

RESULTS Mean HbA1c value for the whole population was 8.97 ± 1.98% (normal 4.7 ± 0.7% [SD]). Only 19 children (0.7%) had ketoacidosis during the 6 months before the study, whereas 593 severe hypoglycemia events occurred in 338 children (13.8%). Control was better in university-affiliated hospitals and centers following > 50 patients, reflecting the importance of access to experienced diabetologists. Children had a mean of 2.3 injections, allegedly performed 2.8 glucose measurements per day, and were seen an average of 4.6 times per year at the center. In the multiple regression analysis, 94% of the variance of HbA1c was explained by our pool of selected variables, with the highest regression coefficient between HbA1c and age (Rc = 0.43, P < 0.0001), then with daily insulin dosage per kilogram (Rc = 0.28, P < 0.0001), mother's age (Rc = 0.26, P < 0.0001), frequency of glucose measurements (Rc = 0.21, P < 0.0001), and diabetes duration (Rc = 0.14, P < 0.0001). Logistic regression identified quality of family support and dietary compliance, two related qualitative and possibly subjective variables, as additional explanatory determinants of HbA1c. The frequency of severe hypoglycemia was 45 per 100 patient-years and correlated with diabetes duration, but not with HbA1c levels or other variables.

CONCLUSIONS Although overall results remain unsatisfactory, 33% of studied French children with type 1 diabetes had HbA1c <8%, the value obtained in Diabetes Control and Complications Trial adolescents treated intensively. Diabetes management in specialized centers should be encouraged.

  • Received August 13, 1997.
  • Revision received April 7, 1998.
  • Accepted April 7, 1998.
  • Copyright © 1998 by the American Diabetes Association

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July 1998, 21(7)
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Factors Associated With Glycemic Control: A cross-sectional nationwide study in 2,579 French children with type 1 diabetes
Myriam Rosilio, Jean-BenoîT Cotton, Marie-Claire Wieliczko, Bénédicte Gendrault, Jean-Claude Carel, Olga Couvaras, Nicole Ser, Pierre Gillet, Sylvie Soskin, Patrick Garandeau, Chantal Stuckens, Bernard Le Luyer, Joseph Jos, Hélène Bony-Trifunovic, Anne-Marie Bertrand, France Leturcq, Antoine Lafuma, The French Pediatric Diabetes Group, Pierre-François Bougnères
Diabetes Care Jul 1998, 21 (7) 1146-1153; DOI: 10.2337/diacare.21.7.1146

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Factors Associated With Glycemic Control: A cross-sectional nationwide study in 2,579 French children with type 1 diabetes
Myriam Rosilio, Jean-BenoîT Cotton, Marie-Claire Wieliczko, Bénédicte Gendrault, Jean-Claude Carel, Olga Couvaras, Nicole Ser, Pierre Gillet, Sylvie Soskin, Patrick Garandeau, Chantal Stuckens, Bernard Le Luyer, Joseph Jos, Hélène Bony-Trifunovic, Anne-Marie Bertrand, France Leturcq, Antoine Lafuma, The French Pediatric Diabetes Group, Pierre-François Bougnères
Diabetes Care Jul 1998, 21 (7) 1146-1153; DOI: 10.2337/diacare.21.7.1146
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