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Hemoglobin A1c ( HbA1c ) changes over time among adolescent and young adult participants in the T1D exchange clinic registry
Author(s) -
Clements Mark A.,
Foster Nicole C.,
Maahs David M.,
Schatz Desmond A.,
Olson Beth A.,
Tsalikian Eva,
Lee Joyce M.,
BurtSolorzano Christine M.,
Tamborlane William V.,
Chen Vincent,
Miller Kellee M.,
Beck Roy W.
Publication year - 2016
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.12295
Subject(s) - medicine , cohort , glycemic , young adult , type 1 diabetes , retrospective cohort study , psychological intervention , medical record , cohort study , diabetes mellitus , pediatrics , demography , gerontology , endocrinology , psychiatry , sociology
Objective Hemoglobin A1c ( HbA1c ) levels among individuals with type 1 diabetes (T1D) influence the longitudinal risk for diabetes‐related complications. Few studies have examined HbA1c trends across time in children, adolescents, and young adults with T1D . This study examines changes in glycemic control across the specific transition periods of pre‐adolescence‐to‐adolescence and adolescence‐to‐young adulthood, and the demographic and clinical factors associated with these changes. Research Design and Methods Available HbA1c lab results for up to 10 yr were collected from medical records at 67 T1D Exchange clinics. Two retrospective cohorts were evaluated: the pre‐adolescent‐to‐adolescent cohort consisting of 85 016 HbA1c measurements from 6574 participants collected when the participants were 8–18 yr old and the adolescent‐to‐young adult cohort, 2200 participants who were 16–26 yr old at the time of 17 279 HbA1c measurements. Results HbA1c in the 8–18 cohort increased over time after age 10 yr until ages 16–17; followed by a plateau. HbA1c levels in the 16–26 cohort remained steady from 16–18, and then gradually declined. For both cohorts, race/ethnicity, income, health insurance, and pump use were all significant in explaining individual variations in age‐centered HbA1c (p < 0.001). For the 8–18 cohort, insulin pump use, age of onset, and health insurance were significant in predicting individual HbA1c trajectory. Conclusions Glycemic control among patients 8–18 yr old worsens over time, through age 16. Elevated HbA1c levels observed in 18 yr‐olds begin a steady improvement into early adulthood. Focused interventions to prevent deterioration in glucose control in pre‐adolescence, adolescence, and early adulthood are needed.