Glycosylated Hemoglobin and Related Factors in Children With Type 1 Diabetes Mellitus Under 20 Years of Age

  • Zahra Razavi Department of Pediatrics, School of Medicine, Hamedan University of Medical Sciences, Hamedan, Iran.
  • Elham Kaviani Department of Pediatrics, School of Medicine, Hamedan University of Medical Sciences, Hamedan, Iran.
  • Javad Fredmal Department of Biostatistics, Hamedan University of Medical Sciences, Hamedan, Iran.
Keywords: Type 1 diabetes mellitus, Hemoglobin A1c, Glycemic control, Child and adolescence, Glycosylated hemoglobin


The number of child and adolescence with type 1 diabetes mellitus (T1DM) is increasing. This study was conducted to assess glycemic control in child and adolescence with type 1 diabetes mellitus and its associated factors in Hamadan (Iran). This was a prospective observational study, dealing with 110 child and adolescence with type 1 diabetes mellitus, who referred to a pediatric diabetes clinic, affiliated to Hamadan University of Medical Sciences in 2012-2014. All blood tests were performed in a single laboratory. In this study, HbA1c levels of 6-7.9%, 8-9.9 and >10% were considered as good, moderate, and poor control. All collected data were recorded in the questionnaire. The number of male and female was equal. HbA1c level was equal to 6-7.9 in 48 patients (43.6%), 8-9.9 in 38 patients (34.5%), and more than 10 in 24 individuals (21.8%). Poor glycemic control was associated with: older age, duration of disease more than 5 years, less glucose monitoring, greater insulin dose, illiterate mothers, and more number of children, and residency in rural regions. Moreover, intensive insulin regimen and more times of insulin injection increased HbA1c level, though the difference was not significant. We concluded that in T1DM child and adolescence, the age, long duration of disease, number of glycemic control, insulin dose and living in urban regions are effective factors on the better control of the HbA1c levels. To improve glycemic control, we suggest more education and social support especially for mothers and rural patients and more blood glucose monitoring


Patterson CC, Dahlquist GG, Gyürüs E, Green A, Soltész G, EURODIAB Study Group. Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–20: a multicentre prospective registration study. Lancet 2009; 373:2027–2033

Vehik K, Hamman FR, Lezote D, Norris JM, Klingensmith G, Bloch C, RewersM, Dabelea D. Increasing incidence of type 1 diabetes in 0- to 17-year-old Colorado youth. Diabetes Care 2007;30: 503–509

Barat P, Valade A, Brosselin P, Alberti C, Maurice-Tison S, Levy- Marchal C. The growing incidence of type 1 diabetes in children: the 17-year French experience in Aquitaine. Diabetes Metab 2008;34:601–605

The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329:977–986.

Barker JM, Yu J, Yu L, Wang J, Miao D, et al. Autoantibody “subspecificity” in type 1 diabetes: risk for organ-specific autoimmunity clusters in distinct groups. Diabetes Care 2005; 28: 850-855.

Hummel S, Hummel M, Banholzer J, Hanak D, Mollenhauer U, et al. Development of autoimmunity to transglutaminase C in children of patients with type 1 diabetes: relationship to islet autoantibodies and infant feeding. Diabetologia 2007; 50: 390-394.

Rewers M, Pihoker C, Donaghue K, Hanas R, Swift P, Klingensmith GJ. Assessment and monitoring of glycemic control in children and adolescents with diabetes. ISPAD clinical practice consensus guidelines 2009 compendium. Pediatr Diabetes 2009;10:71–81

Persson S, Dahlquist G, Gerdtham UG, Steen Carlsson K. Impact of childhood-onset type 1 diabetes on schooling: a population-based register study. Diabetologia 2013;56:1254–1262

Dahlquist G, Kallen B, Swedish Childhood Diabetes Study Group. School performance in children with type 1 diabetes—a population-based register study. Diabetologia 2007;50:957–964

Gerstl EM, Rabl W, Rosenbauer J, Gröbe H, Hofer SE, Krause U, Holl RW. Metabolic control as reflected by HbA1c in children, adolescents and young adults with type 1 diabetes mellitus: combined longitudinal analysis including 27,035 patients from 207 centers in Germany and Austria during the last decade. Eur J Pediatr 2008;167:447–453

Rosenbauer J, Dost A, Karges B, Hungele A, Stahl A, Bachle C, Gerstl EM, Kastendieck C, Hofer SE, Holl RW. Improved metabolic control in children and adolescents with type 1 diabetes: a trend analysis using prospective multicenter data from Germany and Austria. Diabetes Care 2012;35:80–86

Mohammad HA, Farghaly HS, Metwalley KA, Monazea EM, Abd El-Hafeez HA. Predictors of glycemic control in children with Type 1 diabetes mellitus in Assiut-Egypt. Indian J Endocrinol Metab 2012;16: 796-802.

Sherifali D, Ciliska D, O’Mara L. Parenting children with diabetes: exploring parenting styles on children living with type 1 diabetes mellitus. Diabetes Educ 2009;35:476–483

Davis CL, Delamater AM, Shaw KH, La Greca AM, Eidson MS, Perez-Rodriguez JE, Nemery R. Brief report: Parenting styles, regimen adherence, and glycemic control in 4-to 10-yearold children with diabetes. J Pediatr Psychol 2001;26:123–129

Silverstein J, Klingensmith G, Copeland K, Plotnick L, Kaufman F, et al. Care of children and adolescents with type 1 diabetes: a statement of the American Diabetes Association. Diabetes Care 2005; 28: 186-212.

Deng HR,WU G, et al. Cross-sectional study of current situation of glycemic control with type 1 diabetes in Guangdong Province. Zhonghua Yi Xue Za Zhi ,2011; Vol.13:3257-61.

Matini M, Moniri R, Vaali GH. Study of status and risk factors of diabetes control Shahid Beheshti Hospital of Kashan during 2008. Journal of the grace of spring. 2010; 29: 21-26.

Malachy O’Hagan, John N. Harvey. Glycemic Control in Children With Type 1 Diabetes in Wales. Diabetes Care 33,2010;1724–1726.

Scottish study group for the care of the young Diabetics. Factors Influencing Glycemic Control in Young People With Type 1 Diabetes in Scotland. Diabetes Care 2001;24:239–244.

Urakami T, Suzuki J, Yoshida A, Saito H, Ishige M, et al.Association between Sex, Age, Insulin Regimens and Glycemic Control in Children and Adolescents with Type 1 Diabetes. Clin Pediatr Endocrinol 2010; 19: 1-6.

Samuel W. Cutfield1, Jose´ G. B. Derraik, Peter W. Reed, Paul L. Hofman , Craig Jefferies, Wayne S. Cutfield. Early Markers of Glycaemic Control in Children with Type1 Diabetes Mellitus. September 2011, Volume 6(9):25251.

Aschner P, Horton E, Leiter L, Munro N, Skyler J. Practical steps to improving the management of type 1 diabetes: recommendations from the Global Partnership for Effective Diabetes Management. Blackwell Publishing Ltd Int J Clin Pract, February 2010; 64( 3): 305–315.

Cardwell CR, Patterson CC, Allen M, Carson DJ. Diabetes care provision and glycaemic control in Northern Ireland: a UK regional audit. Arch Dis Child 2005;90:468–473.

Razavi Z, Ahmadi M . Efficacy of Thrice-daily versus Twice-daily Insulin Regimens on Glycohemoglobin (Hb A1c) in Type 1 Diabetes Mellitus: A Randomized Controlled Trial. Oman Medical Journal ,2011;Vol. 26(1): 10-13.

Al-Odayani AN, Alsharqi OZ, Ahmad AM, Khalaf Ahmad AM, Al-Borie HM, et al.Children’s glycemic control: mother’s knowledge and socioeconomic status. Glob J Health Sci 2013;5: 214-226.

Marques Rde M, Fornés NS, Stringhini ML. Socioeconomic, demographic, nutritional, and physical activity factors in the glycemic control of adolescents with type 1 diabetes mellitus. Arq Bras Endocrinol Metabol 2011;55: 194-202.

Shulman R, Palmert M, Daneman D. Glycemic control in Brazilian youth with type 1 diabetes. Jornal de Pediatria ,2009; Vol. 85(6):466-468.

How to Cite
Razavi Z, Kaviani E, Fredmal J. Glycosylated Hemoglobin and Related Factors in Children With Type 1 Diabetes Mellitus Under 20 Years of Age. Acta Med Iran. 56(8):516-521.