Ulf Samuelsson1, Isabelle Steineck, Soffia Gubbjornsdottir. 1. Department of Clinical and Experimental Medicine, Division of Pediatrics and Diabetes Research Center, Linköping University Hospital, Linköping, Sweden.
Abstract
BACKGROUND: Intensive treatment of patients with type 1 diabetes delays the onset of long-term complications. OBJECTIVES: On the basis of the information from two nation-wide quality registers, we investigated to which extent HbA1c values 3-15 months after diagnosis in childhood are related to metabolic control, albuminuria, and retinopathy in early adulthood. METHODS: In Sweden, physicians register all children and adolescents with type 1 diabetes mellitus in the Swedish Pediatric Quality Registry. After 18 yr of age, people with diabetes are followed by the Swedish National Diabetes Register. We identified 1543 children and adolescents with a mean age of 13.9 yr at diagnosis and a mean duration of type 1 diabetes mellitus of 7.1 yr. RESULTS: Children and adolescents with poor metabolic control (mean HbA1c ≥ 70 mmol/mol (8.6 %)) adjacent to diagnosis had a significantly higher mean HbA1c value years later as adults than did patients with a good metabolic control [<50 mmol/mol (6.7%) (p < 0.001)]. The patients in the high group were also less physically active and smoked more as adults. The proportion of females was higher in the poor metabolic group. Patients with a high mean HbA1c 3-15 months after diagnosis had significantly more often macroalbuminuria and retinopathy in early adulthood. CONCLUSIONS: Metabolic control adjacent to the diagnosis of type 1 diabetes in childhood or adolescence can predict metabolic control in early adulthood. It is therefore very important that pediatric diabetes teams identify key factors for successful early metabolic control. Actively using quality registries may be one such factor.
BACKGROUND: Intensive treatment of patients with type 1 diabetes delays the onset of long-term complications. OBJECTIVES: On the basis of the information from two nation-wide quality registers, we investigated to which extent HbA1c values 3-15 months after diagnosis in childhood are related to metabolic control, albuminuria, and retinopathy in early adulthood. METHODS: In Sweden, physicians register all children and adolescents with type 1 diabetes mellitus in the Swedish Pediatric Quality Registry. After 18 yr of age, people with diabetes are followed by the Swedish National Diabetes Register. We identified 1543 children and adolescents with a mean age of 13.9 yr at diagnosis and a mean duration of type 1 diabetes mellitus of 7.1 yr. RESULTS:Children and adolescents with poor metabolic control (mean HbA1c ≥ 70 mmol/mol (8.6 %)) adjacent to diagnosis had a significantly higher mean HbA1c value years later as adults than did patients with a good metabolic control [<50 mmol/mol (6.7%) (p < 0.001)]. The patients in the high group were also less physically active and smoked more as adults. The proportion of females was higher in the poor metabolic group. Patients with a high mean HbA1c 3-15 months after diagnosis had significantly more often macroalbuminuria and retinopathy in early adulthood. CONCLUSIONS: Metabolic control adjacent to the diagnosis of type 1 diabetes in childhood or adolescence can predict metabolic control in early adulthood. It is therefore very important that pediatric diabetes teams identify key factors for successful early metabolic control. Actively using quality registries may be one such factor.
Authors: Sripriya Raman; Hongying Dai; Stephen A DeLurgio; David D Williams; Marcus Lind; Susana R Patton; John A Spertus; Mikhail Kosiborod; Mark A Clements Journal: Pediatr Diabetes Date: 2015-09-17 Impact factor: 4.866
Authors: Josephine Haas; Martina Persson; Anna Lena Brorsson; Eva Hagström Toft; Anna Lindholm Olinder Journal: Trials Date: 2017-11-24 Impact factor: 2.279