Abstract
Background
The main objective of this study was to compare future glycemic control in children diagnosed with type 1 diabetes mellitus (T1DM) at toddler age and preschool/school age. In addition, we aimed to examine risk factors known to be associated with future glycated hemoglobin A1c (HbA1c) levels in children diagnosed with T1DM.
Methods
This is a retrospective cohort study of 85 patients diagnosed with T1DM at toddler age (group 1; 0–2.9 years; n = 36) or preschool/school age (group 2; 5–6.9 years; n = 49) who were followed up at the University Children’s Hospital in Zurich for at least 10 consecutive years or until the age of 15 years.
Results
The mean HbA1c level in the first year after diagnosis had a highly predictive value about glycemic control in the following 6 years. In addition, a longer duration of T1DM was associated with higher HbA1c values. HbA1c values did not differ significantly within 11 years after diagnosis between children in the two age groups. Neither was a difference found when comparing the two groups in respect to their chronological age, although a trend was noted (p = 0.09). This trend is very likely due to a longer duration of diabetes in group 1.
Conclusions
HbA1c level in the first year predicts glycemic control for the next 6 years and deterioration of HbA1c values can be noted with longer duration of T1DM. Moreover, our study demonstrated similar future glycemic control in patients diagnosed with T1DM at toddler age and preschool/school age.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Atkinson MA, Bluestone JA, Eisenbarth GS, Hebrok M, Herold KC, et al. How does type 1 diabetes develop? The notion of homicide or beta-cell suicide revisited. Diabetes 2011;60:1370–9.10.2337/db10-1797Search in Google Scholar PubMed
2. Lind M, Svensson AM, Kosiborod M, Gudbjörnsdottir S, PivodicA, et al. Glycemic control and excess mortality in type 1 diabetes. N Engl J Med 2014;371:1972–82.10.1056/NEJMoa1408214Search in Google Scholar PubMed
3. Livingstone SJ, Levin D, Looker HC, Lindsay RS, Wild SH, et al. Estimated life expectancy in a Scottish cohort with type 1 diabetes, 2008–2010. J Am Med Assoc 2015;313:37–44.10.1001/jama.2014.16425Search in Google Scholar
4. Writing Group for the D.E.R.G., Orchard TJ, Nathan DM, ZinmanB, Cleary P, et al. Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality. J Am Med Assoc 2015;313:45–53.10.1001/jama.2014.16107Search in Google Scholar
5. Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group. J Pediatr 1994;125:177–88.10.1016/S0022-3476(94)70190-3Search in Google Scholar
6. Rudberg S, Ullman E, Dahlquist G. Relationship between early metabolic control and the development of microalbuminuria – a longitudinal study in children with type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1993;36:1309–14.10.1007/BF00400811Search in Google Scholar PubMed
7. Svensson M, Eriksson JW, Dahlquist G. Early glycemic control, age at onset, and development of microvascular complications in childhood-onset type 1 diabetes: a population-based study in northern Sweden. Diabetes Care 2004;27:955–62.10.2337/diacare.27.4.955Search in Google Scholar PubMed
8. Petitti DB, Klingensmith GJ, Bell RA, Andrews JS, Dabelea D, et al. Glycemic control in youth with diabetes: the SEARCH for diabetes in Youth Study. J Pediatr 2009;155:668–72.e1-3.10.1016/j.jpeds.2009.05.025Search in Google Scholar PubMed PubMed Central
9. Duca LM, Wang B, Rewers M, Rewers A. Diabetic ketoacidosis at diagnosis of type 1 diabetes predicts poor long-term glycemic control. Diabetes Care 2017;40:1249–55.10.2337/dc17-0558Search in Google Scholar PubMed
10. Rosilio M, Cotton JB, Wieliczko MC, Gendrault B, Carel JC, et al. Factors associated with glycemic control. A cross-sectional nationwide study in 2,579 French children with type 1 diabetes. The French Pediatric Diabetes Group. Diabetes Care 1998;21:1146–53.10.2337/diacare.21.7.1146Search in Google Scholar PubMed
11. Scottish Study Group for the Care of the Young D. Factors influencing glycemic control in young people with type 1 diabetes in Scotland: a population-based study (DIABAUD2). Diabetes Care 2001;24:239–44.10.2337/diacare.24.2.239Search in Google Scholar
12. Variation and trends in incidence of childhood diabetes in Europe. EURODIAB ACE Study Group. Lancet 2000;355:873–6.10.1016/S0140-6736(99)07125-1Search in Google Scholar
13. Gardner SG, Bingley PJ, Sawtell PA, Weeks S, Gale EA. Rising incidence of insulin dependent diabetes in children aged under 5 years in the Oxford region: time trend analysis. The Bart’s-Oxford Study Group. Br Med J 1997;315:713–7.10.1136/bmj.315.7110.713Search in Google Scholar PubMed PubMed Central
14. Karvonen M, Pitkaniemi J, Tuomilehto J. The onset age of type 1 diabetes in Finnish children has become younger. The Finnish Childhood Diabetes Registry Group. Diabetes Care 1999;22:1066–70.10.2337/diacare.22.7.1066Search in Google Scholar PubMed
15. Dahlquist G, Mustonen L. Analysis of 20 years of prospective registration of childhood onset diabetes time trends and birth cohort effects. Swedish Childhood Diabetes Study Group. Acta Paediatr 2000;89:1231–7.10.1080/080352500750027628Search in Google Scholar PubMed
16. Clements MA, Lind M, Raman S, Patton SR, Lipska KJ, et al. Age at diagnosis predicts deterioration in glycaemic control among children and adolescents with type 1 diabetes. BMJ Open Diabetes Res Care 2014;2:e000039.10.1136/bmjdrc-2014-000039Search in Google Scholar PubMed PubMed Central
17. Wolfsdorf J, Craig ME, Daneman D, Dunger D, Edge J, et al. Diabetic ketoacidosis in children and adolescents with diabetes. Pediatr Diabetes 2009;10(Suppl 12):118–33.10.1111/j.1399-5448.2009.00569.xSearch in Google Scholar PubMed
18. Largo RH, Pfister D, Molinari L, Kundu S, Lipp A, et al. Significance of prenatal, perinatal and postnatal factors in the development of AGA preterm infants at five to seven years. Dev Med Child Neurol 1989;31:440–56.10.1111/j.1469-8749.1989.tb04022.xSearch in Google Scholar PubMed
19. Shalitin S, Phillip M. Which factors predict glycemic control in children diagnosed with type 1 diabetes before 6.5 years of age? Acta Diabetol 2012;49:355–62.10.1007/s00592-011-0321-xSearch in Google Scholar PubMed
20. Shalitin S, Gil M, Nimri R, De Vries L, Gavan MY, et al. Predictors of glycaemic control in patients with type 1 diabetes commencing continuous subcutaneous insulin infusion therapy. Diabet Med 2010;27:339–47.10.1111/j.1464-5491.2009.02925.xSearch in Google Scholar PubMed
21. Cummings EA, Sochett EB, Dekker MG, Lawson ML, DanemanD. Contribution of growth hormone and IGF-I to early diabetic nephropathy in type 1 diabetes. Diabetes 1998;47:1341–6.10.2337/diab.47.8.1341Search in Google Scholar PubMed
22. Dahlquist G, Rudberg S. The prevalence of microalbuminuria in diabetic children and adolescents and its relation to puberty. Acta Paediatr Scand 1987;76:795–800.10.1111/j.1651-2227.1987.tb10567.xSearch in Google Scholar PubMed
© 2019 Walter de Gruyter GmbH, Berlin/Boston
