Abstract
BackgroundType 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 (HbA1c) levels at 24 months after T1DM diagnosis, so that diabetic children at risk of poor glycaemic control may be identified.Methods229 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, HbA1c level, and insulin dose.ResultsFactors at diagnosis that were associated with higher HbA1c 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 HbA1c 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 HbA1c at 24 months was consequently developed.ConclusionsDeterioration 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.
Highlights
Type 1 diabetes mellitus (T1DM) may lead to severe long-term health consequences, such as renal failure, blindness, as well as heart and cerebrovascular disease [1,2]
Previous data have shown that intensive therapy to maintain blood glucose concentrations near the normal range delays the onset and slows the progression of adverse outcomes associated with T1DM, such as retinopathy, nephropathy and neuropathy [2]
Subjects were included in the study if the following criteria were met: blood tests showed T1DM antibodies glutamic acid decarboxylase (GAD) and/or islet antigen 2 (IA2) at presentation, ongoing requirement for insulin, and regular attendance ($3 visits per annum) to the Paediatric Diabetes Service at Starship
Summary
Type 1 diabetes mellitus (T1DM) may lead to severe long-term health consequences, such as renal failure, blindness, as well as heart and cerebrovascular disease [1,2]. Glycosylated haemoglobin (HbA1c) monitoring has been shown to improve glycaemic control when added to conventional blood glucose testing, and it is standard practice in the management of patients with T1DM. The monitoring of HbA1c levels may minimize possible short- and long-term adverse health outcomes. Type 1 diabetes mellitus (T1DM) may lead to severe long-term health consequences. We aimed to identify factors present at diagnosis and 6 months later that were associated with glycosylated haemoglobin (HbA1c) levels at 24 months after T1DM diagnosis, so that diabetic children at risk of poor glycaemic control may be identified
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