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. 2021 Aug;148(2):e2020048942.
doi: 10.1542/peds.2020-048942.

Hemoglobin A1c Patterns of Youth With Type 1 Diabetes 10 Years Post Diagnosis From 3 Continents

Jennifer L Sherr  1 , Anke Schwandt  2   3 , Helen Phelan  4   5 , Mark A Clements  6   7 , Reinhard W Holl  2   3 , Paul Z Benitez-Aguirre  5   8 , Kellee M Miller  9 , Joachim Woelfle  10 , Thomas Dover  11   12 , David M Maahs  13   14 , Elke Fröhlich-Reiterer  15 , Maria E Craig  5   8
Affiliations

Hemoglobin A1c Patterns of Youth With Type 1 Diabetes 10 Years Post Diagnosis From 3 Continents

Jennifer L Sherr et al. Pediatrics. 2021 Aug.

Abstract

Objectives: Distinct hemoglobin A1c (HbA1c) trajectories during puberty are identified in youth with established type 1 diabetes (T1D). We used data from 3 international registries to evaluate whether distinct HbA1c trajectories occur from T1D onset.

Methods: Participants were <18 years old at diagnosis with at least 1 HbA1c measured within 12 months post diagnosis, along with ≥3 duration-year-aggregated HbA1c values over 10 years of follow-up. Participants from the Australasian Diabetes Data Network (n = 7292), the German-Austrian-Luxembourgian-Swiss diabetes prospective follow-up initiative (Diabetes Patienten Verlaufsdokumentation) (n = 39 226) and the US-based Type 1 Diabetes Exchange Clinic Registry (n = 3704) were included. With group-based trajectory modeling, we identified unique HbA1c patterns from the onset of T1D.

Results: Five distinct trajectories occurred in all 3 registries, with similar patterns of proportions by group. More than 50% had stable HbA1c categorized as being either low stable or intermediate stable. Conversely, ∼15% in each registry were characterized by stable HbA1c >8.0% (high stable), and ∼11% had values that began at or near the target but then increased (target increase). Only ∼5% of youth were above the target from diagnosis, with an increasing HbA1c trajectory over time (high increase). This group differed from others, with higher rates of minority status and an older age at diagnosis across all 3 registries (P ≤ .001).

Conclusions: Similar postdiagnostic HbA1c patterns were observed across 3 international registries. Identifying the youth at the greatest risk for deterioration in HbA1c over time may allow clinicians to intervene early, and more aggressively, to avert increasing HbA1c.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Sherr has had research support from the National Institutes of Health, Juvenile Diabetes Research Foundation, and Helmsley Charitable Trust, and her institution has had research support from Medtronic and Insulet. Dr Sherr serves as a consultant to Cecelia Health, Lexicon, Lilly, Insulet, Medtronic, and Sanofi. She also is a member of the advisory board for Bigfoot Biomedical, Cecelia Health, Insulet, Medtronic, and the Type 1 Diabetes Fund. Dr Clements has had research support from the National Institutes of Health, Juvenile Diabetes Research Foundation, and Helmsley Charitable Trust, and his institution has had research support from Dexcom, Abbott Diabetes Care, Eli Lilly, Tolerion, Novo Nordisk, and Provention. Dr Clements has served as a consultant for Medtronic and Eli Lilly and serves as Chief Medical Officer for Glooko. Dr Woelfle serves as a consultant to Novo Nordisk and Ipsen. Dr Dover has consulted for AstraZeneca, Boehringer-Ingelheim, Merk-Sharp and Dohme, Novo Nordisk, Lilly, Servier, Sanofi, and Medtronic. Dr Dover has also been on advisory boards for AstraZeneca, Medtronic, and Novo Nordisk. Dr Maahs has had research support from the National Institutes of Health, Juvenile Diabetes Research Foundation, National Science Foundation, and Helmsley Charitable Trust, and his institution has had research support from Medtronic, Dexcom, Insulet, Bigfoot Biomedical, Tandem, and Roche. Dr Maahs has consulted for Abbott, the Helmsley Charitable Trust, Sanofi, Novo Nordisk, Eli Lilly, Medtronic, Insulet, and Dompe; the other authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
HbA1c trajectories with 95% confidence intervals among youth with T1D from the time of diagnosis. A, ADDN (N = 7292). B, The German-Austrian-Luxembourgian-Swiss diabetes prospective follow-up (DPV; N = 39 226). C, US T1DX (N = 3704).
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References

    1. Nathan DM, Genuth S, Lachin J, et al. ; 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(14):977–986 - PubMed
    1. Diabetes Control and Complications Trial Research Group . Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. J Pediatr. 1994;125(2):177–188 - PubMed
    1. Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group . Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus. JAMA. 2002;287(19):2563–2569 - PMC - PubMed
    1. DCCT/EDIC research group . Effect of intensive diabetes treatment on albuminuria in type 1 diabetes: long-term follow-up of the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications study. Lancet Diabetes Endocrinol. 2014;2(10):793–800 - PMC - PubMed
    1. Lachin JM, White NH, Hainsworth DP, Sun W, Cleary PA, Nathan DM; Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group . Effect of intensive diabetes therapy on the progression of diabetic retinopathy in patients with type 1 diabetes: 18 years of follow-up in the DCCT/EDIC. Diabetes. 2015;64(2):631–642 - PMC - PubMed

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