Longitudinal trajectories of metabolic control from childhood to young adulthood in type 1 diabetes from a large German/Austrian registry: a group-based modeling approach
OBJECTIVE Worsening of glycemic control in type 1 diabetes during puberty is a common observation. However, HbA1c remains stable or even improves for some youths. The aim is to identify distinct patterns of glycemic control in type 1 diabetes from childhood to young adulthood. RESEARCH DESIGN AND ME...
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| Hauptverfasser: | , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
23 November 2016
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| In: |
Diabetes care
Year: 2017, Jahrgang: 40, Heft: 3, Pages: 309-316 |
| ISSN: | 1935-5548 |
| DOI: | 10.2337/dc16-1625 |
| Online-Zugang: | Verlag, kostenfrei, Volltext: http://dx.doi.org/10.2337/dc16-1625 Verlag, kostenfrei, Volltext: http://care.diabetesjournals.org/content/40/3/309 
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| Verfasserangaben: | Anke Schwandt, Julia M. Hermann, Joachim Rosenbauer, Claudia Boettcher, Désirée Dunstheimer, Jürgen Grulich-Henn, Oliver Kuss, Birgit Rami-Merhar, Christian Vogel, Reinhard W. Holl, on behalf of the DPV Initiative |
| Zusammenfassung: | OBJECTIVE Worsening of glycemic control in type 1 diabetes during puberty is a common observation. However, HbA1c remains stable or even improves for some youths. The aim is to identify distinct patterns of glycemic control in type 1 diabetes from childhood to young adulthood. RESEARCH DESIGN AND METHODS A total of 6,433 patients with type 1 diabetes were selected from the prospective, multicenter diabetes patient registry Diabetes-Patienten-Verlaufsdokumentation (DPV) (follow-up from age 8 to 19 years, baseline diabetes duration ≥2 years, HbA1c aggregated per year of life). We used latent class growth modeling as the trajectory approach to determine distinct subgroups following a similar trajectory for HbA1c over time. RESULTS Five distinct longitudinal trajectories of HbA1c were determined, comprising group 1 = 40%, group 2 = 27%, group 3 = 15%, group 4 = 13%, and group 5 = 5% of patients. Groups 1-3 indicated stable glycemic control at different HbA1c levels. At baseline, similar HbA1c was observed in group 1 and group 4, but HbA1c deteriorated in group 4 from age 8 to 19 years. Similar patterns were present in group 3 and group 5. We observed differences in self-monitoring of blood glucose, insulin therapy, daily insulin dose, physical activity, BMI SD score, body-height SD score, and migration background across all HbA1c trajectories (all P ≤ 0.001). No sex differences were present. Comparing groups with similar initial HbA1c but different patterns, groups with higher HbA1c increase were characterized by lower frequency of self-monitoring of blood glucose and physical activity and reduced height (all P < 0.01). CONCLUSIONS Using a trajectory approach, we determined five distinct longitudinal patterns of glycemic control from childhood to early adulthood. Diabetes self-care, treatment differences, and demographics were related to different HbA1c courses. |
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| Beschreibung: | Gesehen am 14.05.2018 |
| Beschreibung: | Online Resource |
| ISSN: | 1935-5548 |
| DOI: | 10.2337/dc16-1625 |