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Treatment adherence and BMI reduction are key predictors of HbA1c 1 year after diagnosis of childhood type 2 diabetes in the United Kingdom
Author(s) -
Candler Toby P.,
Mahmoud Osama,
Lynn Richard M.,
Majbar Abdalmonen A.,
Barrett Timothy G.,
Shield Julian P. H.
Publication year - 2018
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.12761
Subject(s) - medicine , type 1 diabetes , diabetes mellitus , pediatrics , type 2 diabetes , reduction (mathematics) , endocrinology , geometry , mathematics
Background/Objective Type 2 Diabetes (T2DM) is increasing in childhood especially among females and South‐Asians. Our objective was to report outcomes from a national cohort of children and adolescents with T2DM 1 year following diagnosis. Methods Clinician reported, 1‐year follow‐up of a cohort of children (<17 years) diagnosed with T2DM reported through the British Paediatric Surveillance Unit (BPSU) (April 2015‐April 2016). Results One hundred (94%) of 106 baseline cases were available for review. Of these, five were lost to follow up and one had a revised diagnosis. Mean age at follow up was 15.3 years. Median BMI standard deviation scores (SDS) was 2.81 with a decrease of 0.13 SDS over a year. HbA1c <48 mmol/mol (UK target) was achieved in 38.8%. logHbA1c was predicted by clinician reported compliance and attendance concerns ( β = 0.12, P = <0.0001) and change in body mass index (BMI) SDS at 1‐year ( β = 0.13, P =0.007). In over 50%, clinicians reported issues with compliance and attendance. Mean clinic attendance was 75%. Metformin was the most frequently used treatment at baseline (77%) and follow‐up (87%). Microalbuminuria prevalence at 1‐year was 16.4% compared to 4.2% at baseline and was associated with a higher HbA1c compared to those without microalbuminuria (60 vs 49 mmol/mol, P = 0.03). Conclusions Adherence to treatment and a reduction in BMI appear key to better outcomes a year after T2DM diagnosis. Retention and clinic attendance are concerning. The prevalence of microalbuminuria has increased 4‐fold in the year following diagnosis and was associated with higher HbA1c.