Aveni Haynes1, Julia M Hermann2,3, Helen Clapin4, Sabine E Hofer5, Beate Karges6, Timothy W Jones7,4, Elizabeth A Davis7,4, Reinhard W Holl. 1. Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia aveni.haynes@health.wa.gov.au. 2. Central Institution for Biomedical Engineering, Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany. 3. German Center for Diabetes Research, München-Neuherberg, Germany. 4. Department of Diabetes and Endocrinology, Perth Children's Hospital, Perth, Western Australia, Australia. 5. Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria. 6. Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, Aachen, Germany. 7. Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
Abstract
OBJECTIVE: To investigate temporal trends in glycemic control and severe hypoglycemia rates for pediatric patients with type 1 diabetes from 1995 to 2016 by analyzing data from the longitudinal, prospective, population-based German/Austrian (Diabetes Patient History Documentation [DPV]) and Western Australian (Western Australian Children's Diabetes Database [WACDD]) diabetes registries. RESEARCH DESIGN AND METHODS: Patients diagnosed with type 1 diabetes aged <15 years were identified from the DPV (N = 59,883) and WACDD (N = 2,595) registries and data extracted for all clinic visits occurring between 1995 and 2016, inclusive. Mean HbA1c and severe hypoglycemia (self-reported loss of consciousness/convulsion) rates were calculated per 100 patient-years. RESULTS: Between 1995 and 2016, the annual mean HbA1c decreased from 8.3 to 7.8% in the DPV cohort and from 9.2 to 8.3% in the WACDD cohort. Over the same period, the severe hypoglycemia rate decreased by an annual average of 2% (relative risk 0.983 [95% CI 0.981, 0.986]) in the DPV cohort and 6% (relative risk 0.935 [95% CI 0.934, 0.937]) in the WACDD cohort. Concomitant decreasing trends in both HbA1c and severe hypoglycemia rates were observed in boys and girls, all age-groups, and injection therapy/pump regimen groups. CONCLUSIONS: Over the past two decades, there have been concurrent improvements in HbA1c and decreasing severe hypoglycemia rates in two contemporary, longitudinal, population-based pediatric cohorts of type 1 diabetes. Translation of these data into clinical practice and patient education may reduce fear of hypoglycemia and enable better glycemic control.
OBJECTIVE: To investigate temporal trends in glycemic control and severe hypoglycemia rates for pediatric patients with type 1 diabetes from 1995 to 2016 by analyzing data from the longitudinal, prospective, population-based German/Austrian (DiabetesPatient History Documentation [DPV]) and Western Australian (Western Australian Children's Diabetes Database [WACDD]) diabetes registries. RESEARCH DESIGN AND METHODS: Patients diagnosed with type 1 diabetes aged <15 years were identified from the DPV (N = 59,883) and WACDD (N = 2,595) registries and data extracted for all clinic visits occurring between 1995 and 2016, inclusive. Mean HbA1c and severe hypoglycemia (self-reported loss of consciousness/convulsion) rates were calculated per 100 patient-years. RESULTS: Between 1995 and 2016, the annual mean HbA1c decreased from 8.3 to 7.8% in the DPV cohort and from 9.2 to 8.3% in the WACDD cohort. Over the same period, the severe hypoglycemia rate decreased by an annual average of 2% (relative risk 0.983 [95% CI 0.981, 0.986]) in the DPV cohort and 6% (relative risk 0.935 [95% CI 0.934, 0.937]) in the WACDD cohort. Concomitant decreasing trends in both HbA1c and severe hypoglycemia rates were observed in boys and girls, all age-groups, and injection therapy/pump regimen groups. CONCLUSIONS: Over the past two decades, there have been concurrent improvements in HbA1c and decreasing severe hypoglycemia rates in two contemporary, longitudinal, population-based pediatric cohorts of type 1 diabetes. Translation of these data into clinical practice and patient education may reduce fear of hypoglycemia and enable better glycemic control.
Authors: Maria J Redondo; Ingrid Libman; David M Maahs; Sarah K Lyons; Mindy Saraco; Jane Reusch; Henry Rodriguez; Linda A DiMeglio Journal: Diabetes Care Date: 2021-01-11 Impact factor: 19.112