Mark A Clements1,2, Anke Schwandt3,4, Kim C Donaghue5,6, Kellee Miller7, Ursula Lück8, Jennifer J Couper9, Nicole Foster7, Carmen Schröder10, Helen Phelan11, David Maahs12, Nicole Prinz3,4, Maria E Craig5,6,13. 1. Department of Pediatrics, Division of Endocrinology and Diabetes, Children's Mercy Hospital, Kansas City, Missouri. 2. Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri. 3. Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany. 4. German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany. 5. Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia. 6. University of Sydney, New South Wales, Australia. 7. Jaeb Center for Health Research, Tampa, Florida. 8. Medical Centre, University St. Pölten, St. Pölten, Austria. 9. Womens and Childrens Hospital and Robinson Research Institute, University of Adelaide, Adelaide, South Australia. 10. Department of Pediatrics, University of Greifswald, Greifswald, Germany. 11. John Hunter Children's Hospital, Newcastle, Australia. 12. Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Palo Alto, California. 13. University of New South Wales, Sydney, New South Wales, Australia.
Abstract
OBJECTIVES: Only a fraction of youth meet established targets for glycemic control; many experience deteriorating control over time. We compared trajectories of hemoglobin A1c (HbA1c) among youth from three trans-continental type 1 diabetes (T1D) registries and identified clinical variables associated with the odds of following increasing vs stable trajectories. RESEARCH DESIGN AND METHODS: Analyses included longitudinal data from 15 897 individuals age 8 to 18 with T1D for at least 2 years and HbA1c measurements in at least 5 years during the observation period. Cohorts were selected from Australasian Diabetes Data Network (ADDN; Australia), German/Austrian/Luxembourgian Diabetes-Patienten-Verlaufsdokumentation initiative (DPV; Germany/Austria/Luxembourga), and the T1D Exchange Clinic Network (T1DX; US) clinic registries. Group-based trajectory modeling and multivariable logistic regression identified unique HbA1c trajectories and their predictors. RESULTS: Five heterogeneous trajectories of glycemic control in each registry were identified: low, intermediate, high stable; intermediate and high increasing. The overall HbA1c level for each trajectory group tended to be lowest in the DPV, higher in the ADDN, and highest in the T1DX. The absolute level of HbA1c and the proportion of individuals within each trajectory varied across registries: 17% to 22% of individuals followed an increasing trajectory. Compared with maintaining a stable trajectory, following an increasing trajectory was significantly associated with ethnic minority status, lower height z-score, higher BMI z-score, insulin injection therapy, and the occurrence of severe hypoglycemia; however, these factors were not consistent across the three registries. CONCLUSIONS: We report the first multinational registry-based comparison of glycemic control trajectories among youth with T1D from three continents and identify possible targets for intervention in those at risk of an increasing HbA1c trajectory.
OBJECTIVES: Only a fraction of youth meet established targets for glycemic control; many experience deteriorating control over time. We compared trajectories of hemoglobin A1c (HbA1c) among youth from three trans-continental type 1 diabetes (T1D) registries and identified clinical variables associated with the odds of following increasing vs stable trajectories. RESEARCH DESIGN AND METHODS: Analyses included longitudinal data from 15 897 individuals age 8 to 18 with T1D for at least 2 years and HbA1c measurements in at least 5 years during the observation period. Cohorts were selected from Australasian Diabetes Data Network (ADDN; Australia), German/Austrian/Luxembourgian Diabetes-Patienten-Verlaufsdokumentation initiative (DPV; Germany/Austria/Luxembourga), and the T1D Exchange Clinic Network (T1DX; US) clinic registries. Group-based trajectory modeling and multivariable logistic regression identified unique HbA1c trajectories and their predictors. RESULTS: Five heterogeneous trajectories of glycemic control in each registry were identified: low, intermediate, high stable; intermediate and high increasing. The overall HbA1c level for each trajectory group tended to be lowest in the DPV, higher in the ADDN, and highest in the T1DX. The absolute level of HbA1c and the proportion of individuals within each trajectory varied across registries: 17% to 22% of individuals followed an increasing trajectory. Compared with maintaining a stable trajectory, following an increasing trajectory was significantly associated with ethnic minority status, lower height z-score, higher BMI z-score, insulin injection therapy, and the occurrence of severe hypoglycemia; however, these factors were not consistent across the three registries. CONCLUSIONS: We report the first multinational registry-based comparison of glycemic control trajectories among youth with T1D from three continents and identify possible targets for intervention in those at risk of an increasing HbA1c trajectory.
Authors: Rachel G Miller; Trevor J Orchard; Suna Onengut-Gumuscu; Wei-Min Chen; Stephen S Rich; Tina Costacou Journal: Diabet Med Date: 2021-03-02 Impact factor: 4.213
Authors: Shivani Agarwal; Lauren G Kanapka; Jennifer K Raymond; Ashby Walker; Andrea Gerard-Gonzalez; Davida Kruger; Maria J Redondo; Michael R Rickels; Viral N Shah; Ashley Butler; Jeffrey Gonzalez; Alandra S Verdejo; Robin L Gal; Steven Willi; Judith A Long Journal: J Clin Endocrinol Metab Date: 2020-08-01 Impact factor: 5.958
Authors: Jennifer L Sherr; Anke Schwandt; Helen Phelan; Mark A Clements; Reinhard W Holl; Paul Z Benitez-Aguirre; Kellee M Miller; Joachim Woelfle; Thomas Dover; David M Maahs; Elke Fröhlich-Reiterer; Maria E Craig Journal: Pediatrics Date: 2021-08 Impact factor: 9.703