May 29, 2015
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Poor disease control common among younger patients with type 1 diabetes

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Adolescents and young adults with type 1 diabetes struggle to maintain glycemic control and target HbA1c levels, increasing their risk for future complications of the disease, according to research in Diabetes Care.

Analysis of the T1D Exchange Clinic Registry data, collected for 4 years, also showed that treatment outcomes must be improved across all age groups, and that severe hypoglycemia and diabetic ketoacidosis remain common complications of treatment, particularly in older and younger patients, respectively.

“While disease management at every age needs to improve, it’s especially disconcerting how poorly we continue to manage type 1 diabetes in adolescents,” study researcher Kellee M. Miller, MPH, assistant director of the Jaeb Center for Health Research in Tampa, Florida, said in a press release. “This age group in particular faces unique challenges to diabetes management, including hormone fluctuations that affect blood sugar control, the sometimes overwhelming demands of diabetes self-care and even phases of rebelling against parents and physicians, which may lead to complications treating their disease.”

Miller and colleagues at other institutions analyzed data from 16,061 children and adults with type 1 diabetes aged 2 to 95 years (50% women; 83% white) who received treatment within the T1D Exchange Clinic Network, which includes 76 U.S.-based pediatric and adult endocrinology practices in 33 states. Researchers collected data between September 2010 and August 2012, and again between September 2013 and December 2014.

Dana Ball

Dana Ball

During 4 years of follow-up, the overall average HbA1c increased from 8.2% to 8.4%, with worsening over time largely limited to 13- to 25-year-olds, according to researchers.

Only 14% of 18- to 25-year-olds met the American Diabetes Association’s recommended HbA1c goal of less than 7% vs. 30% of adults.

HbA1c levels were highest among black participants, those with a lower household income, and those who performed self-monitoring of blood glucose fewer than four times per day. Participants using an insulin pump or continuous glucose monitor tended to have lower HbA1c values.

Researchers noted elevations in HbA1c levels across every age group, but only 5% were being treated with an adjunctive glucose-monitoring agent - for most, metformin.

“Treatment with metformin has been associated with only a modest lowering of HbA1c in adults with type 1 diabetes,” the researchers wrote. “These observations underscore the continuing need for the testing of new classes of glucose-lowering agents that have been approved for treatment of type 2 diabetes in patients with type 1 diabetes.”

Additional studies are needed to understand the challenges in treating teenagers and young adults with type 1 diabetes, according to researchers.

“Our data show that while advances have been made in type 1 diabetes, the condition remains a tremendous burden, particularly in youth,” Dana Ball, executive director and co-founder of the T1D Exchange, said in a press release. “This only furthers our resolve to accelerate the research that is going to reduce the burden of living with type 1 and improve outcomes.” - by Regina Schaffer

Disclosure: Miller reports no relevant financial disclosures. See the full study for a list of all other authors’ relevant financial disclosures.

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