Early markers of glycaemic control in children with type 1 diabetes mellitus

Abstract

Background: Type 1 diabetes mellitus (T1DM) may lead to severe long-term health consequences. In a longitudinal study, we aimed to identify factors present at diagnosis and 6 months later that were associated with glycosylated haemoglobin (HbA(1c)) levels at 24 months after T1DM diagnosis, so that diabetic children at risk of poor glycaemic control may be identified.

Methods: 229 children <15 years of age diagnosed with T1DM in the Auckland region were studied. Data collected at diagnosis were: age, sex, weight, height, ethnicity, family living arrangement, socio-economic status (SES), T1DM antibody titre, venous pH and bicarbonate. At 6 and 24 months after diagnosis we collected data on weight, height, HbA(1c) level, and insulin dose.

Results: Factors at diagnosis that were associated with higher HbA(1c) levels at 6 months: female sex (p<0.05), lower SES (p<0.01), non-European ethnicity (p<0.01) and younger age (p<0.05). At 24 months, higher HbA(1c) was associated with lower SES (p<0.001), Pacific Island ethnicity (p<0.001), not living with both biological parents (p<0.05), and greater BMI SDS (p<0.05). A regression equation to predict HbA(1c) at 24 months was consequently developed.

Conclusions: Deterioration in glycaemic control shortly after diagnosis in diabetic children is particularly marked in Pacific Island children and in those not living with both biological parents. Clinicians need to be aware of factors associated with poor glycaemic control beyond the remission phase, so that more effective measures can be implemented shortly after diagnosis to prevent deterioration in diabetes control.

Figure 1. Mean changes in HbA_1c between 6 and 24 months after diagnosis for Europeans (n = 157; solid black line), Maori (n = 16; dashed black), Pacific Islanders (n = 24; dashed gray), and Other ethnicities (n = 32; solid gray).

Data are mean ± SEM. *p<0.05 and ***p<0.001 for temporal changes within each ethnic group.