Format

Send to

Choose Destination
See comment in PubMed Commons below
BMJ Open Diabetes Res Care. 2014 Oct 7;2(1):e000039. doi: 10.1136/bmjdrc-2014-000039. eCollection 2014.

Age at diagnosis predicts deterioration in glycaemic control among children and adolescents with type 1 diabetes.

Author information

1
Children's Mercy Hospitals and Clinics , Kansas City, Missouri , USA ; University of Missouri-Kansas City , Kansas City, Missouri , USA ; University of Kansas Medical Center , KansasCity, Kansas , USA.
2
Institute of Medicine, University of Gothenburg , Gothenburg , Sweden.
3
Children's Mercy Hospitals and Clinics , Kansas City, Missouri , USA ; University of Missouri-Kansas City , Kansas City, Missouri , USA.
4
University of Kansas Medical Center , KansasCity, Kansas , USA.
5
Yale University School of Medicine , New Haven, Connecticut , USA.
6
Saint Luke's Mid America Heart Institute , Kansas City, Missouri , USA.
7
Children's Mercy Hospitals and Clinics , Kansas City, Missouri , USA.
8
University of Missouri-Kansas City , Kansas City, Missouri , USA ; Saint Luke's Mid America Heart Institute , Kansas City, Missouri , USA.

Abstract

BACKGROUND:

Poor glycemic control early in the course of type 1 diabetes mellitus (T1DM) increases the risk for microvascular complications. However, predictors of deteriorating control after diagnosis have not been described, making it difficult to identify high-risk patients and proactively provide aggressive interventions.

OBJECTIVE:

We examined whether diagnostic age, gender, and race were associated with deteriorating glycemic control during the first 5 years after diagnosis.

PARTICIPANTS:

2218 pediatric patients with T1DM.

METHODS:

We conducted a longitudinal cohort study of pediatric patients with T1DM from the Midwest USA, 1993-2009, evaluating within-patient glycated hemoglobin (HbA1c) trajectories constructed from all available HbA1c values within 5 years of diagnosis.

RESULTS:

52.6% of patients were male; 86.1% were non-Hispanic Caucasian. The mean diagnostic age was 9.0±4.1 years. The mean number of HbA1c values/year/participant was 2.4±0.9. HbA1c trajectories differed markedly across age groups, with older patients experiencing greater deterioration than their younger counterparts (p<0.001). HbA1c trajectories, stratified by age, varied markedly by race (p for race×diagnostic age <0.001). Non-Hispanic African-American patients experienced higher initial HbA1c (8.7% vs 7.6% (71.6 vs 59.6 mmol/mol); p<0.001), and greater deterioration in HbA1c than non-Hispanic Caucasian patients across diagnostic ages (rise of 2.04% vs 0.99% per year (22.3 vs 10.8 mmol/mol/year); p<0.0001).

CONCLUSIONS:

Older diagnostic age and black race are major risk factors for deterioration in glycemic control early in the course of T1DM. These findings can inform efforts to explore the reasons behind these differences and develop preventive interventions for high-risk patients.

KEYWORDS:

Adolescents / Children; Age of Diabetes Onset; Glycemic Control; Type 1

PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for BMJ Publishing Group Icon for PubMed Central
    Loading ...
    Support Center