Associations between HbA1c and complications in children diagnosed with type 1 diabetes before age 6: A 30-year
Chris Moran1, Taya A Collyer2, Amy Brown3
1School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; National Centre for Healthy Ageing, Frankston, Victoria, Australia; Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia; Department of Geriatric Medicine, Peninsula Health, Mornington, Victoria, Australia; Department of Home, Acute and Community, Alfred Health, Caulfield, Victoria, Australia.
Insights
Adolescent hyperglycemia significantly increases neuropathy risk in adulthood for children with type 1 diabetes (T1D). Effective glycemic management during adolescence is crucial for preventing long-term complications.
Area of Science:
- Pediatrics
- Endocrinology
- Diabetes Research
Background:
- Early-onset type 1 diabetes (T1D) requires long-term monitoring to prevent microvascular complications.
- Understanding glycemic trajectories from childhood through adulthood is essential for risk stratification.
Purpose of the Study:
- To analyze the 30-year glycemic patterns in children with early-onset T1D.
- To identify critical developmental stages contributing to microvascular disease.
Main Methods:
- Longitudinal cohort study (Cognition and Longitudinal Assessment of Risk Factors over 30 Years) in Australia.
- Recruitment of children diagnosed with T1D between 1990-1992.
- Assessment of HbA1c levels and microvascular complications (neuropathy, retinopathy, nephropathy) over 30 years.
Main Results:
- Higher mean HbA1c levels were observed during adolescence compared to childhood and adulthood.
- Adolescent hyperglycemia was significantly associated with increased adult neuropathy risk.
- No significant association was found between adolescent glycemic control and retinopathy or nephropathy.
Conclusions:
- Adolescent glycemic control is a critical determinant of adult neuropathy risk in T1D, irrespective of childhood glycemic levels.
- Enhanced support for individuals with adolescent hyperglycemia is vital during the transition to adult diabetes care.
Aims:
To examine 30-year glycemic trajectory in children with early-onset type 1 diabetes (T1D) and ascertain which stages of childhood and adolescence were most contributory to subsequent microvascular disease.
Methods:
We recruited children diagnosed with T1D between 1990-1992 into the Cognition and Longitudinal Assessment of Risk Factors over 30 Years cohort study in Australia. HbA1c was collected from medical records and microvascular complications assessed through self-reports, clinical screenings, retinal photographs, and urinary albumin-creatinine testing.
Results:
We recruited 30 of the 43 eligible children from the original cohort (Female = 56 %; mean diagnosis age = 2.9 years). After an average of 29.7 years (SD = 3.9 years), 13 participants (33 %) developed neuropathy, 19 (63 %) diabetes-related eye disease, and 3 (10 %) nephropathy. Mean HbA1c estimates during adolescence (9.0 % [74.9 mmol/mol], 95 %CI 8.6-9.3[70.5-78.1]) were higher than childhood (8.2 % [66.1 mmol/mol], 95 %CI 7.8-8.5[61.7-69.4], p < 0.001) and adulthood (8.2 % [66.1 mmol/mol], 95 %CI 7.8-8.5[61.7-69.4]). There was a statistically significant association between greater deviation from mean childhood HbA1c and increased neuropathy risk (RRR = 7.8, 95 %CI 1.1-57.4, p = 0.009) but not retinopathy or nephropathy (p ≥ 0.06).
Conclusions:
Regardless of pre-existing childhood control, adolescent hyperglycemia leads to higher neuropathy risk in adulthood. Adolescent glycemic management is crucial, and individuals with adolescent hyperglycemia may require more support transitioning to adult care.
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