ปัจจัยที่มีผลต่อระดับน้ำตาลใน 12 เดือนแรกของการวินิจฉัยโรคเบาหวานชนิดที่ 1 ในเด็กอายุต่ำกว่า 15 ปี

Meijinee Densriwiwat

Authors

Meijinee Densriwiwat Department of Pediatrics, Buddhachinaraj Phitsanulok Hospital

Keywords:

type 1 diabetes, children, glycated hemoglobin

Abstract

Type 1 diabetes is one of the most common chronic diseases in children. The objectives of this descriptive retrospective cohort study were to determine factors of glycemic control in the first 12 months of diagnosis of type 1 diabetes in children under 15 years. Demographic and clinical data were collected from 84 children diagnosed between January 2009 and June 2022, and glycated hemoglobin (HbA1c) were followed for 12 months. Factors of glycemic control were analyzed by comparing groups of HbA1c more than 9%(poor control) or not. In the 7th-12th month, univariate analysis showed poor control was associated with age at diagnosis more than 10 years (OR = 4.85, 95%CI 1.17-25.5), universal health coverage scheme (OR = 4.58, 95%CI 1.13-30.9) and children who lived with father and/or mother (OR = 2.93, 95%CI 1.01-9.82). Multivariate analysis showed poor control was associated with universal health coverage scheme (Adj OR = 6.43, 95%CI 1.43-47.0) and children who lived with father and/or mother (Adj OR = 3.43, 95%CI 1.02-13.4). In conclusion, factors of poor glycemic control in the 7th-12th month of diagnosis of type 1 diabetes are age at diagnosis more than 10 years, universal health coverage scheme and children who lived with father and/or mother

References

Deerochanawong C, Ferrario A. Diabetes management in Thailand: A literature review of the burden, costs, and outcome. Global Health 2013;9:11. doi: 10.1186/1744-8603-9-11

American Diabetes Association Professional Practice Committee. 2. Classification and diagnosis of diabetes: Standard of medical care in diabetes–2025. Diabetes Care 2025;48(Suppl 1):S27-49. https://doi.org/10.2337/dc25-s002

American Diabetes Association Professional Practice Committee. 14. Children and adolescents: standard of medical care in diabetes–2025. Diabetes Care 2025;48(Suppl 1):S283-305. https://doi.org/10.2337/dc25-s014

Sperling MA, Laffel LM. Current management of glycemia in children with type 1 diabetes mellitus, N Engl J Med 2022;386:1155-64 doi:10.1056/NEJMcp2112175

Likitmaskul S, Angsusingha K, Morris S, Kiattisakthavee P, Chaichanwatanakul K, Tuchinada C. Type 1 diabetes in Thai children aged 0-14 years. J Med Assoc Thai 1999;82(8):826-32.

Tuchinda C, Likitmaskul S, Unachak K, Panamonta O. Patarakijavanich N, Chetthakul T. The epidemiology of type 1 diabetes in Thai children. J Med Assoc Thai 2002;85(6):648-52.

Dejkhamron p, Santiprabhob J, Likitmaskul S, Deerochanawong C, Rawdaree P, Tharavanij T, et al, T1DDAR CN. Young-onset diabetes patients in Thailand: Data from Thai type 1 diabetes and diabetes diagnosed age before 30 years Registry, Care and Network (T1DDAR CN). J Diabetes Investig 2021. doi: 10.1111/jdi.13732

Densriwiwat M. Clinical characteristics and treatment outcomes of diabetes in children under 15 years. Buddhachinaraj Med J 2022;39(1):68-81

Sperling MA, Wolfsdorf JI, MenonRK, Tamborlane WV, Maahs D, Battelino T, et al Diabetes mellitus. In: Sperling MA, editor. Pediatric Endocrinology. 5thed. Philadelphia, Pennsylvania State, USA: Elsevier; 2021. p. 814-83.

Gregory JW, Cameron FJ, Joshi K, Eiswirth M, Garrett C, Garvey K, et al, ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes in adolescence. Pediatr Diabetes 2022;23:857-71 doi:10:1111/pedi.13408

Preechasuk L, Tantasuwan S, Likitmaskul S, Santiprabhob J, Lertbannaphong O, Plengvidhya N, et al. Clinical characteristics, glycemic control, and microvascular complications compared between young-onset type 1 and type 2 diabetes patients at Siriraj Hospital-A Tertiary Referral Center. Diabetes Metab Syndr Obes 2022:15;1375-87. doi: 10.2147/DMSO.S354787

Clements MA, Lind M, Raman S, Patton SR, Lipska KJ, Fridlington AG, et al. Age at diagnosis predicts deterioration in glycemic control among children and adolescents with type 1 diabetes. BMJ Open Diabetes Res Care 2014;2(1):e000039. doi:10.1136/bmjdrc-2014-000039

Paes VM, Charalampopoulos D, Edge J, Taylor-Robinson D, Stephenson T, Amin R. Predictors of glycemic control in the first year of diagnosis of childhood onset type 1 diabetes: A systematic review of

quantitative evidence. Pediatr Diabetes 2018;19:18-26. doi:10.1111/pedi.12530

Friedemann-Sanchez G, Capistrant BD, Ron J, Novak L, Zuijdwijk C, Ogle GD, et al. Caregiving for children with type 1 diabetes and clinical outcomes in central India: the IDREAM study. Pediatr Diabetes 2018;19(3):527-33. doi: 10.1111/pedi.12567

Akesson K, Hanberger L, Samuelesson U. The influence of age, gender, insulin dose, BMI and blood pressure on metabolic control in young patients with type 1 diabetes. Pediatr Diabetes 2015;16(8):581-6 doi:10.1111/pedi.12219

Kamrath C, Rosenbauer J, Eckert AJ, Ohlenschlager U, Sydlik C, Nellen-Hellmuth N, et al. Glycated hemoglobin at diagnosis of type 1 diabetes and at follow up in children and adolescents during the COVID-19 pandemic in Germany. Pediatr Diabetes 2022;23(6):749-53. doi 10.1111/pedi.13338

Predieri B, Leo F, Candia F, Lucaccioni L, Madeo SF, Pugliese M, et al. Glycemic control improvement in Italian children and adolescents with type 1 diabetes followed through telemedicine during lockdown due to the COVID-19 pandemic. Front Endocrinol 2020;11:595735. doi: 10.3389/fendo.2020.595735

World Health Organization (WHO). Classification of diabetes mellitus 2019 [online]. 2019 Apr 21 [cited 2025 Oct 1]. Available from: https://www.who.int/publications/i/item/classification-of-diabetes-mellitus

Santiprabhob J. Pathogenesis of type 1 diabetes. In: Santiprabhob J, Lertwattanarak R, Sriaudthaporn S. editors. Diabetes mellitus in children, adolescents, and young adults. Bangkok, Thailand: P.A. Living Co., Ltd.; 2022. p.43-74.

Thai Society for Pediatric Endocrinology. Management guideline for diabetic ketoacidosis and hyperglycemic hyperosmolar state in children and adolescents [online]. [revised 2023 Apr, cited 2025 Oct 1]. Available from: https://thaipedendo.org/wp-content/uploads/2023/04/Diabetic Ketoacidosis_2566_DISTRIBUTED.pdf

Dejkhamron P, Santiprabhob J, Likitmaskul S, Deerochanawong C, Rawdaree P, Tharavanij T, et al. Type 1 diabetic management and outcome: A multicenter study in Thailand. J Diabetes Investig 2021;12(4):516-26. doi: 10.1111/jdi.13390