Effect of early glycemic control on HbA1c tracking and development of vascular complications after 5 years of childhood onset type 1 diabetes: Systematic review and meta-analysis.

Veena Mazarello Paes,Jessica K Barrett,Heather Chesters,Dimitrios Charalampopoulos,David B Dunger,David C Taylor‐Robinson,Terence J Stephenson,Russell M Viner

doi:10.1111/pedi.12850

Abstract

ObjectiveA systematic review and meta‐analysis was conducted to investigate if glycemic control measured by glycated hemoglobin (HbA1c) levels near diagnosis are predictive of future glycemic outcomes and vascular complications in childhood onset type 1 diabetes (T1D).MethodsEvidence was gathered using electronic databases (MEDLINE, EMBASE, Web of Science, CINAHL, Scopus, and Cochrane Library up to February 2017) and snowballing techniques. Studies investigating the association between the exposure “early glycemic control” and main outcome: “tracking of early control” and secondary outcome: risk of future complications; in children and young people aged 0 to 19 years at baseline; were systematically double‐reviewed, quality assessed, and outcome data extracted for synthesis and meta‐analysis.FindingsFive studies (N = 4227 participants) were eligible. HbA1c levels were sub‐optimal throughout the study period but tended to stabilize in a “track” by 6 months after T1D diagnosis. The group with low HbA1c <53 mmol/mol (<7%) at baseline had lower long‐term HbA1c levels than the higher HbA1c group. The estimated standardized mean difference between the sub groups showed a reduction of HbA1c levels on average by 1.6% (range −0.95% to −2.28%) from baseline. Only one study investigated the association between early glycemic control and development of vascular complications in childhood onset T1D.InterpretationsGlycemic control after the first few months of childhood onset T1D, remains stable but sub‐optimal for a decade. The low and high HbA1c levels at baseline seem to “track” in their respective tracks during the 10‐year follow‐up, however, the initial difference between groups narrows over time. PROSPERO: CRD42015024546 http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015024546

Highlights

Glycated haemoglobin (HbA1c) levels, a measure for glycaemic control is the main predictor of long-term type 1 diabetes (T1D) outcomes [1,2,3]
The low and high HbA1c levels at baseline seem to “track” in their respective tracks during the 10-year follow-up the initial difference between groups narrows over time
Three sets of search terms were used relating to population, exposure and outcome

Summary

Introduction

Glycated haemoglobin (HbA1c) levels, a measure for glycaemic control is the main predictor of long-term type 1 diabetes (T1D) outcomes [1,2,3]. Studies mainly in adults have shown a link between poor glycaemic control in the early phase following T1D diagnosis and long-term HbA1c levels, with an increased risk of developing vascular complications and mortality [6, 7]. Others suggest that mean HbA1c levels nearer to diagnosis are predictive of HbA1c levels in the subsequent years, even lifetime, regardless of the type of insulin regimen [15,16,17] This phenomenon, known as glycaemic “tracking”, is poorly understood [18]. It is important to investigate the evidence on this phenomenon in order to identify if there exists a window period in the initial phase of T1D diagnosis, during which appropriate resources could be mobilised to deliver targeted interventions to those at risk of developing poorer long-term glycaemic outcomes and vascular complications

Methods

Results

Conclusion