Prediction of glycaemic control in young children and adolescents with type 1 diabetes mellitus using mixed-effects logistic regression modelling

ObjectivesGlycaemic control in children and adolescents with type 1 diabetes mellitus can be challenging, complex and influenced by many factors. This study aimed to identify patient characteristics that were predictive of satisfactory glycaemic control in the paediatric population using a logistic regression mixed-effects (population) modelling approach.MethodsThe data were obtained from 288 patients aged between 1 and 22 years old recorded retrospectively over 3 years (1852 HbA1c observations). HbA1c status was categorised as ‘satisfactory’ or ‘unsatisfactory’ glycaemic control, using an a priori cut-off value of HbA1c ≥ 9% (75 mmol/mol), as used routinely by the hospital’s endocrine paediatricians. Patients’ characteristics were tested as covariates in the model as potential predictors of glycaemic control.ResultsThere were three patient characteristics identified as having a significant influence on glycaemic control: HbA1c measurement at the beginning of the observation period (Odds Ratio (OR) = 0.30 per 1% HbA1c increase, 95% confidence interval (CI) = 0.20–0.41); Age (OR = 0.88 per year increase, 95% CI = 0.80–0.94), and fractional disease duration (disease duration/age, OR = 0.80 per 0.10 increase, 95% CI = 0.66–0.93) were collectively identified as factors contributing significantly to lower the probability of satisfactory glycaemic control.ConclusionsThe study outcomes may prove useful for identifying paediatric patients at risk of having unsatisfactory glycaemic control, and who could require more extensive monitoring, support, or targeted interventions.### 研究目的 1型糖尿病患儿及青少年的血糖控制往往颇具挑战，过程复杂且受多种因素影响。本研究旨在采用逻辑回归混合效应（群体）模型方法，筛选出儿科人群中可预测血糖控制良好的患者特征。 ### 研究方法 本研究数据来自288名年龄介于1~22岁的患者，回顾性收集了3年的随访数据，共计1852次糖化血红蛋白（HbA1c）检测记录。按照医院内分泌儿科常规使用的预先设定临界值（HbA1c≥9%，即75 mmol/mol），将患者的血糖控制状态划分为「血糖控制良好」与「血糖控制不佳」两类。将患者特征作为协变量纳入模型，作为血糖控制的潜在预测因子。 ### 研究结果 本研究共识别出3项对血糖控制具有显著影响的患者特征：观察期初的糖化血红蛋白水平（每升高1% HbA1c，比值比（OR）=0.30，95%置信区间（CI）=0.20~0.41）、年龄（每增加1岁，OR=0.88，95%CI=0.80~0.94）以及病程占比（病程/年龄，每升高0.10，OR=0.80，95%CI=0.66~0.93），上述因素均可显著降低血糖控制良好的发生概率。 ### 研究结论 本研究结果可用于识别存在血糖控制不佳风险的儿科患者，此类患者可能需要更全面的监测、支持或针对性干预措施。