Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 22:2022:8554991.
doi: 10.1155/2022/8554991. eCollection 2022.

Trends in Glycemia between 2002 and 2016 among Incident Youth Cohorts Early in the Course of Type 1 Diabetes: The SEARCH for Diabetes in Youth Study

Daria Igudesman  1 , Beth A Reboussin  2 , Katherine J Souris  1 , Catherine Pihoker  3 , Lawrence Dolan  4 , Jean M Lawrence  5 , Sharon Saydah  6 , Dana Dabelea  7 , Santica Marcovina  8 , Noémie Clouet-Foraison  8 , Faisal S Malik  3 , Elizabeth J Mayer-Davis  1   9
Affiliations

Trends in Glycemia between 2002 and 2016 among Incident Youth Cohorts Early in the Course of Type 1 Diabetes: The SEARCH for Diabetes in Youth Study

Daria Igudesman et al. J Diabetes Res. .

Abstract

Objective: Hyperglycemia early in the course of type 1 diabetes (T1D) may increase the risk of cardiometabolic complications later in life. We tested the hypothesis that there were temporal trends in population-level glycemia and insulin pump use near T1D diagnosis among incident youth cohorts diagnosed between 2002 and 2016.

Methods: Weighted and adjusted regression models were applied to data from the SEARCH for Diabetes in Youth study to analyze trends in hemoglobin A1c (HbA1c), suboptimal glycemia (HbA1c > 9% or not), and insulin pump use among youth with T1D within 30 months of diagnosis. We tested the interaction of year with race and ethnicity, sex, and insulin regimen to assess potential disparities.

Results: Among the 3,956 youth with T1D, there was a small, clinically insignificant reduction in HbA1c between 2002 (7.9% ± 1.5) and 2016 (7.8% ± 2.4) (fully adjusted change by year (-0.013% [95% CI -0.026, -0.0008], p = 0.04). The proportion of youth with suboptimal glycemia increased with each year, but the adjusted odds did not change. Insulin pump use increased more than fivefold. Although interaction effects of time with race and ethnicity, sex, and insulin regimen were not detected, in 2016, suboptimal glycemia was 4.3 and 1.8 times more prevalent among Black and Hispanic than among non-Hispanic White youth, respectively.

Conclusions: There was not a clinically significant population-level improvement in glycemia across incident youth cohorts early in the course of T1D, despite severalfold increases in insulin pump use. Comprehensive clinical interventions to improve glycemia early in the T1D course and address disparities are urgently needed.

PubMed Disclaimer

Conflict of interest statement

EMD has consulted for Helmsley Charitable Trust. All other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Mean hemoglobin A1c across incident youth cohorts with type 1 diabetes, overall and by race and ethnicity subgroup. (a) There was a small but clinically nonsignificant reduction in the fully adjusted overall change in hemoglobin A1c (HbA1c) over time. (b) The interaction of time with race and ethnicity for HbA1c was not statistically significant, but racial and ethnic disparities persisted over time. In particular, mean HbA1c was higher among Black youth than among non-Hispanic White youth in all index years. The Other race and ethnicity subgroup includes youth with an Other, Unknown, Asian or Pacific Islander, or Native American race and a Hispanic ethnicity. Sample sizes for subgroups across index years ranged from n = 40-93 for Black youth, n = 42-117 for Hispanic youth, n = 7-30 for youth with an Other race, and n = 149-475 for non-Hispanic White youth. Abbreviations: Hispa—Hispanic; Other—Other or Unknown; White—non-Hispanic.
See this image and copyright information in PMC

References

    1. Anderzén J., Samuelsson U., Gudbjörnsdottir S., Hanberger L., Åkesson K. Teenagers with poor metabolic control already have a higher risk of microvascular complications as young adults. Journal of Diabetes and its Complications . 2016;30(3):533–536. doi: 10.1016/j.jdiacomp.2015.12.004. - DOI - PubMed
    1. Miller K. M., Foster N. C., Beck R. W., et al. Current state of type 1 diabetes treatment in the U.S.: updated data from the T1D exchange clinic registry. Diabetes Care . 2015;38(6):971–978. doi: 10.2337/dc15-0078. - DOI - PubMed
    1. Divers J., Mayer-Davis E. J., Lawrence J. M., et al. Trends in incidence of type 1 and type 2 diabetes among youths—selected counties and Indian reservations, United States, 2002–2015. Morbidity and Mortality Weekly Report . 2020;69(6):161–165. doi: 10.15585/mmwr.mm6906a3. - DOI - PMC - PubMed
    1. Dabelea D., Stafford J. M., Mayer-Davis E. J., et al. Association of type 1 diabetes vs type 2 diabetes diagnosed during childhood and adolescence with complications during teenage years and young adulthood. Journal of the American Medical Association . 2017;317(8):825–835. doi: 10.1001/jama.2017.0686. - DOI - PMC - PubMed
    1. Snyder L., Stafford J., Dabelea D., et al. Socio-economic, demographic, and clinical correlates of poor glycaemic control within insulin regimens among children with type 1 diabetes: the SEARCH for Diabetes in Youth Study. Diabetic Medicine . 2019;36(8):1028–1036. doi: 10.1111/dme.13983. - DOI - PMC - PubMed