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Does poor early metabolic control predict subsequent poor control in young children with type 1 diabetes: an
Claude M Chemtob1, Carl J Hochhauser, Eyal Shemesh
1Department of Psychiatry Pediatrics, Mount Sinai School of Medicine, New York, New York, USA. claude.chemtob@nyumc.org
Insights
Poor metabolic control in the second year of type 1 diabetes diagnosis predicts long-term poor control. Early interventions targeting families with poor metabolic control in year 2 can improve outcomes.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disease Research
- Diabetes Mellitus Management
Background:
- Type 1 diabetes mellitus (T1DM) management requires sustained metabolic control.
- Predictors of long-term metabolic control in T1DM are not fully understood.
- Early glycemic control may influence future disease trajectory.
Purpose of the Study:
- To investigate if poor metabolic control in the initial years of T1DM predicts control in subsequent years.
- To determine the predictive value of Year 1 and Year 2 metabolic control on long-term outcomes.
Main Methods:
- Retrospective cohort review of urban children diagnosed with T1DM (1992-2005).
- Odds ratios calculated to assess Year 1 and Year 2 control as predictors for Years 3-6.
- Cox regression analyses used to evaluate progression to sustained poor control.
Main Results:
- Metabolic control in the first year post-diagnosis did not reliably predict future control.
- Poor metabolic control in the second year after diagnosis strongly predicted subsequent poor control.
- Year 2 poor control was associated with a faster progression to sustained poor metabolic control.
Conclusions:
- Year 2 metabolic control is a significant predictor of long-term glycemic control in T1DM.
- Interventions targeting families with poor Year 2 control may optimize medical outcomes and quality of life.
- Focusing on Year 2 non-adherence and metabolic enhancement is a strategic investment.
Background:
We sought to determine whether poor metabolic control during the early stages of type 1 diabetes mellitus predicts control during subsequent years. We hypothesized that poor control in the first year after diagnosis would predict poor control in the following year, and that poor control in the second year after diagnosis would predict poor metabolic control in subsequent years.
Methods:
We conducted a retrospective review of a cohort of urban children treated for diabetes at our institution who were diagnosed between 1992 and 2005. We calculated odds ratios to determine whether control in year 1 or in year 2 predicted control in Years 3-6. Cox regression analyses were used to determine whether poor early control predicted progression to subsequent poor control.
Results:
Metabolic control in the first year after diagnosis was not a good predictor of future control. However, poor metabolic control in the second year after diagnosis was highly predictive of poor control in subsequent years and predicted faster progression to poor control.
Conclusion:
The findings suggest that poor metabolic control in year 2 may be a predictor of subsequent poor metabolic control. Targeting prevention interventions to reduce non-adherence and to enhance metabolic control to families that show poor metabolic control in Year 2 may prove to be an optimum investment in terms of improved medical outcomes and enhanced quality of life.
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