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Diabetes Care. 2017 Mar;40(3):309-316. doi: 10.2337/dc16-1625. Epub 2016 Dec 22.

Longitudinal Trajectories of Metabolic Control From Childhood to Young Adulthood in Type 1 Diabetes From a Large German/Austrian Registry: A Group-Based Modeling Approach.

Author information

1
Institute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, Germany anke.schwandt@uni-ulm.de.
2
German Center for Diabetes Research (DZD), Neuherberg, Germany.
3
Institute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, Germany.
4
Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
5
Division of Pediatric Endocrinology and Diabetology, Centre of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany.
6
Department of Pediatrics, Clinical Center Augsburg, Augsburg, Germany.
7
Department of Pediatrics, University of Heidelberg, Heidelberg, Germany.
8
Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
9
Department of Pediatrics, Children's Hospital Chemnitz, Chemnitz, Germany.

Abstract

OBJECTIVE:

Worsening of glycemic control in type 1 diabetes during puberty is a common observation. However, HbA1c remains stable or even improves for some youths. The aim is to identify distinct patterns of glycemic control in type 1 diabetes from childhood to young adulthood.

RESEARCH DESIGN AND METHODS:

A total of 6,433 patients with type 1 diabetes were selected from the prospective, multicenter diabetes patient registry Diabetes-Patienten-Verlaufsdokumentation (DPV) (follow-up from age 8 to 19 years, baseline diabetes duration ≥2 years, HbA1c aggregated per year of life). We used latent class growth modeling as the trajectory approach to determine distinct subgroups following a similar trajectory for HbA1c over time.

RESULTS:

Five distinct longitudinal trajectories of HbA1c were determined, comprising group 1 = 40%, group 2 = 27%, group 3 = 15%, group 4 = 13%, and group 5 = 5% of patients. Groups 1-3 indicated stable glycemic control at different HbA1c levels. At baseline, similar HbA1c was observed in group 1 and group 4, but HbA1c deteriorated in group 4 from age 8 to 19 years. Similar patterns were present in group 3 and group 5. We observed differences in self-monitoring of blood glucose, insulin therapy, daily insulin dose, physical activity, BMI SD score, body-height SD score, and migration background across all HbA1c trajectories (all P ≤ 0.001). No sex differences were present. Comparing groups with similar initial HbA1c but different patterns, groups with higher HbA1c increase were characterized by lower frequency of self-monitoring of blood glucose and physical activity and reduced height (all P < 0.01).

CONCLUSIONS:

Using a trajectory approach, we determined five distinct longitudinal patterns of glycemic control from childhood to early adulthood. Diabetes self-care, treatment differences, and demographics were related to different HbA1c courses.

PMID:
28007778
DOI:
10.2337/dc16-1625
[Indexed for MEDLINE]

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