Assessment of risk factors of poor metabolic control in type 1 diabetic children assisted in a public hospital in Argentina.

OBJECTIVE: To evaluate predictive risk variables of poor diabetes control that are present at the onset of the disease. SUBJECTS AND METHODS: A prospective cohort study was carried out in a population of children with type 1 diabetes mellitus by means of a survey with information related to the clinical control of the patients, the sociodemographic and economic situations of their families, and the importance that the families attached to health care. The sample population had had the disease for over 2 yr, had no associated pathology, and was followed in an Argentinean hospital. RESULTS: Data from 148 patients, 71 male (48%), were collected, with a mean hemoglobin A1c (HbA1c) of 9.3 +/- 1.62%. Patients with HbA1c <8.4% (25th percentile) were considered as having better metabolic control (BC), and those with HbA1c >10% (75th percentile) were considered with poorer control (PC). PC was significantly associated with the fact that the patients' biological parents did not live together (p = 0.01) and had not done the diabetic education together at debut of diabetes (p = 0.007). A linear regression model was used to analyze predictors of BC: presence of both parents during diabetes instruction (OR: 3.82), both parents lived together with the patient (OR: 2.39), and lower age of patients (OR: 0.89). Predictors of PC were unsatisfied basic food needs (OR: 4.33) and mothers' low level of education (OR: 2.13). CONCLUSIONS: This study showed that socioeconomic and familial factors were strongly associated with metabolic control, and they will allow us to make an early detection of those patients who are more susceptible of having poor progression of diabetes.