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Age at diagnosis predicts deterioration in glycaemic control among children and adolescents with type 1 diabetes
  1. Mark A Clements1,2,3,
  2. Marcus Lind4,
  3. Sripriya Raman1,2,
  4. Susana R Patton3,
  5. Kasia J Lipska5,
  6. Amanda G Fridlington1,2,
  7. Fengming Tang6,
  8. Phil G Jones6,
  9. Yue Wu1,
  10. John A Spertus2,6,
  11. Mikhail Kosiborod2,6
  1. 1Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
  2. 2University of Missouri-Kansas City, Kansas City, Missouri, USA
  3. 3University of Kansas Medical Center, KansasCity, Kansas, USA
  4. 4Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
  5. 5Yale University School of Medicine, New Haven, Connecticut, USA
  6. 6Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
  1. Correspondence to Dr Mark A Clements; maclements{at}cmh.edu

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.

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

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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