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

Abstract

Objectives: Glycaemic 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. Methods: The 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. Results: There 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. Conclusions: The 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.L6176064012017-08-08 <br />2017-08-10 <br />