Динамічна оцінка поширеності та глікемічного контролю цукрового діабету I типу в дитячій популяції

Abstract

Glycated hemoglobin (HbAc1) remains one of the most valuable methods of glycemic control among patients with diabetes mellitus (DM). Its target level in children and adolescents is ≤7% according to the recommendations of ISPAD (2018) and ≤7.5% – ADA (2020), but the presence of complications and labile course of type I diabetes mellitus (T1DM) in children and adolescents requires an individual approach to achieve optimal glycemic control. The level of glycated hemoglobin determines the risk of concomitant purulent-inflammatory diseases (PID) and the restoration of systemic homeostasis after the surgery. High HbAc1 levels during the last 90 days before the surgery significantly increase the length of hospital stay among adult patients. Currently, there are no published data on the level of glycemic control in children with T1DM in Vinnytsia region, which is extremely important in assessing the risk of complications and treatment outcomes of this population in a surgical department. Purpose – to analysis and assessment of the prevalence of T1DM and glycemic control among children with T1DM in Vinnytsia region in 2013, 2016 and 2017. Materials and methods. We carried a retrospective study to assess the prevalence of T1DM among the pediatric population of Vinnytsia region through the period from 2013 to 2017 by analyzing the reports of the Vinnytsia Regional Clinical Endocrinology Center and demographic data of the Main Department of Statistics in Vinnytsia Region, case histories of patients treated at Vinnytsia Regional Children’s Hospital. Number of patients with T1DM in 2013 was – 321, in 2016–358, in 2017–399 patients. The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from parents to conduct the research. HbAc1 was used to assess glycemic control. The value of HbAc1 ≤7.5% was considered as optimal, >7.5–9.0% – suboptimal, >9.1% – poor. Patients with no HbAc1 available were excluded from further study. Fisher’s exact test was used to compare the groups. P-value ˂0.05 was considered statistically significant. Results. During the study period, there was an increase in the prevalence of T1DM in the pediatric population. Particularly, in 2013 this indicator was equal to – 1.08‰, in 2016 – 1.23‰, and in 2017 – 1.37‰ (p=0.1266; p=0.0015, compared to 2017, respectively), which corresponds to the estimated global trends. The primary incidence of T1DM in Vinnytsia region was: 0.017% in 2013, 0.015% in 2016, 0.022% in 2017, with the peak of the manifestation at the age of 6 and 10. Average indicators of glycemic control based on HbA1c were at the level of 8.73±1.82% in 2013, 8.60±1.52% in 2016, 8.85±1.88% in 2017, respectively. In 2013 glycemic control was assessed as optimal in 27.5% (88/319) of children, suboptimal – 37.5% (120/319), poor – 35% (111/319). In 2016 the number of patients with optimal HbAc1 decreased to 25% (83/336), suboptimal level was found in 41% (139/336), poor – in 34% (114/336), respectively. In 2017 the optimal level of HbAc1 was recorded in only 21% (68/329), suboptimal – in 41% (135/329), poor – in 38% (126/329), respectively. There is an increase in the number of patients with poor glycemic control and HbA1c exceeding 11% in 2017 (42/329) compared to the corresponding indicator in 2016 (24/336), p=0.0191. Clinical manifestations of poor glycemic control in the study population were acute complications (ketosis, ketoacidosis), which were accompanied by abdominal pain, nausea and vomiting and required treatment in the intensive care unit. Purulent-inflammatory diseases (PID) of the abdominal cavity in children with T1DM were accompanied by a combination of clinical and laboratory data of decompensation of T1DM, a significant increase in WBC and diffuse abdominal pain. Macroscopic and pathomorphological characteristics of the appendix and peritoneum corresponded to destructive forms of PID in the presence of a short period from the disease onset. The course of the postoperative period in children with PID of the abdominal cavity in the setting of T1DM was labile and required insulin correction. Conclusions. The prevalence of T1DM among children in Vinnytsia region is growing (1.08‰ – in 2013, in 1.37‰ – in 2017; p=0.0015). Glycemic control in this population is within suboptimal limits (>7.5–9.0%) during the period from 2013 to 2017. As of 2017, more than a third of pediatric patients (38%) have poor glycemic control. The number of patients with HbA1c >11% significantly increased in 2017 compared to 2016 (p=0.0191). The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: type I diabetes mellitus, glycemic control, glycated hemoglobin, children.