Abstract:
BACKGROUND:There is marked variation in diabetes outcomes for children and adolescents across the UK. We used modelling techniques to examine the independent contributions of deprivation, ethnicity, insulin pump use, and health service use on HbA1c trajectories across adolescence. METHODS:Prospective data from a large UK Paediatric & Adolescent Diabetes Service on subjects with type 1 diabetes (T1D) aged 9-17 years from January 2008 to December 2013: 2560 HbA1c datapoints were available on 384 patients [193 (50.4%) female]. Sequential multilevel growth models assessed the effects of sex, duration of diabetes, deprivation, ethnicity, insulin pump use, and health service use on HbA1c . Growth mixture models were used to identify discrete HbA1c trajectories across adolescence. RESULTS:Mean clinic HbA1c decreased from 2008 to 2013 by 0.122% (95% confidence interval: 0.034, 0.210; P = .007) per year. The optimal multilevel growth model showed mean HbA1c increased with age (B = 0.414, P < .0001), and that mean HbA1c was predicted by white/British ethnicity (B = -0.748, P = .004), clinic visits (B = 0.041, P = .04), and pump use (B = -0.568, P < .0001) but not deprivation. The optimal mixture model was a four trajectory group solution, with 45.1% in Good Control, 39.6% with Deteriorating Control, 6.5% with Rapidly Deteriorating Control, and 8.8% in Poor Control across adolescence. Only pump use predicted trajectory group membership, being protective against membership of all other trajectories compared with Good Control. CONCLUSIONS:Increasing uptake of insulin pumps and ensuring access to health services are likely to be the most effective means of reducing inequalities in outcomes of T1D in children and young people.
journal_name
Pediatr Diabetesjournal_title
Pediatric diabetesauthors
Viner RM,White B,Amin R,Peters C,Khanolkar A,Christie D,Hindmarsh PCdoi
10.1111/pedi.12407subject
Has Abstractpub_date
2017-08-01 00:00:00pages
384-391issue
5eissn
1399-543Xissn
1399-5448journal_volume
18pub_type
杂志文章abstract:OBJECTIVE:Type 2 diabetes mellitus (T2DM) is increasingly common among children and adolescents. However, achievement of good metabolic control has been difficult in this population. The aim of this study was to survey pediatric endocrine and diabetes specialists regarding the issues they consider to be barriers to suc...
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journal_title:Pediatric diabetes
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journal_title:Pediatric diabetes
pub_type: 杂志文章
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journal_title:Pediatric diabetes
pub_type: 杂志文章
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更新日期:2009-09-01 00:00:00
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journal_title:Pediatric diabetes
pub_type: 杂志文章
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abstract:OBJECTIVE:Avoiding complications is paramount in diabetes management, but little is known about how, when, and what diabetes professionals disclose to parents and youths about this topic. RESEARCH DESIGN AND METHOD:Pediatric diabetes experts (n = 534) were surveyed about their practices and attitudes regarding informi...
journal_title:Pediatric diabetes
pub_type: 杂志文章
doi:10.1111/j.1399-5448.2008.00438.x
更新日期:2009-02-01 00:00:00
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journal_title:Pediatric diabetes
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journal_title:Pediatric diabetes
pub_type: 杂志文章
doi:10.1111/j.1399-5448.2009.00601.x
更新日期:2010-08-01 00:00:00
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journal_title:Pediatric diabetes
pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:2004-12-01 00:00:00
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journal_title:Pediatric diabetes
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更新日期:2020-12-01 00:00:00
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journal_title:Pediatric diabetes
pub_type: 杂志文章
doi:10.1111/pedi.12859
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journal_title:Pediatric diabetes
pub_type: 杂志文章
doi:10.1111/pedi.12692
更新日期:2018-05-20 00:00:00
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journal_title:Pediatric diabetes
pub_type: 杂志文章
doi:10.1111/pedi.12108
更新日期:2014-09-01 00:00:00
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journal_title:Pediatric diabetes
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更新日期:2018-08-01 00:00:00
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journal_title:Pediatric diabetes
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pub_type: 杂志文章,多中心研究
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更新日期:2011-06-01 00:00:00
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journal_title:Pediatric diabetes
pub_type: 杂志文章,评审
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更新日期:2019-02-01 00:00:00
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journal_title:Pediatric diabetes
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2007-04-01 00:00:00
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journal_title:Pediatric diabetes
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更新日期:2011-05-01 00:00:00
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journal_title:Pediatric diabetes
pub_type: 杂志文章,评审
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更新日期:2004-01-01 00:00:00
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journal_title:Pediatric diabetes
pub_type: 已发布勘误
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更新日期:2015-09-01 00:00:00