161-OR: Trends in Glycemic Control between 2002 and 2016 among Youth Recently Diagnosed with Type 1 Diabetes: The SEARCH for Diabetes in Youth Study

Abstract

Objective: To determine whether glycemia early in the course of type 1 diabetes changed between 2002 and 2016 across discrete youth cohorts. Research Design and Methods: Data from 3,956 youth in the SEARCH for Diabetes in Youth study were used to test whether glycemia worsened between 2002 and 2016 among successive cohorts of youth with type 1 diabetes examined within 30 months of diagnosis. We used linear regression for hemoglobin A1c (HbA1c) and logistic regression for poor glycemic control (HbA1c>9%) stratified by diabetes duration (<6 months, 6-12 months, and 12-30 months) at the time of measurement. Models included survey weights and were adjusted for potential demographic confounders. Results: Fully adjusted models revealed that mean HbA1c and frequency of poor glycemic control remained stable over time across successive youth cohorts with type 1 diabetes. Overall mean unadjusted HbA1c was 7.9% ± 1.5 (63 mmol/mol ± 16.4) in 2002 and 7.8% ± 2.4 (62 mmol/mol ± 26.2) in 2016, p=0.6 for trend. Estimates from weighted linear regression models found no overall change in HbA1c with index year, but a small linear reduction in HbA1c with each index year in the <6 months diabetes duration stratum, which was no longer statistically significant after adjusting for age, sex, race/ethnicity, and clinical site. No time trends were found for either of the other two duration strata (6-12 and 12-30 months). Although interaction effects with race/ethnicity and gender were not detected, the proportion of youth with poor glycemic control was higher among non-white (mean 28.9%, range 24.9-33.7%) than among white youth (mean 12.5%, range 8.8-17.8%) across all years. Conclusions: HbA1c levels remained stable but higher than recommended across discrete cohorts of SEARCH youth with type 1 diabetes duration ≤ 30 months, particularly among non-white youth. Future studies should elucidate predictors of elevated glycemia among youth early in the course of type 1 diabetes. Disclosure D. Igudesman: None. F. Malik: None. E. J. Mayer-davis: None. B. A. Reboussin: None. K. J. Souris: None. C. Pihoker: None. L. M. Dolan: None. S. Saydah: None. D. Dabelea: None. N. Clouet-foraison: None. S. M. Marcovina: None. Funding National Institute for Health Research (1UC4DK108173-01); Centers for Disease Control and Prevention (RFPDP15-002); Kaiser Permanente Southern California (U18DP006133, U48/CCU919219, U01DP000246, U18DP002714); University of Colorado Denver (U18DP006139, U48/CCU819241-3, U01DP000247, U18DP000247-06A1); Cincinnati Children’s Hospital Medical Center (U18DP006134, U48/CCU519239, U01DP000248, 1U18DP002709); University of North Carolina at Chapel Hill (U18DP006138, U48/CCU419249, U01DP000254, U18DP002708); Seattle Children’s Hospital (U18DP006136, U58/CCU019235-4, U01DP000244, U18DP002710-01); Wake Forest University School of Medicine (U18DP006131, U48/CCU919219, U01DP000250, 200-2010-35171); South Carolina Clinical and Translational Research Institute at the Medical University of South Carolina (UL1TR001450); Seattle Children’s Hospital and the University of Washington (UL1TR00423); University of Colorado Pediatric Clinical and Translational Research Center (UL1TR000154); Barbara Davis Center for Diabetes at the University of Colorado Denver (P30-DK-57516); University of Cincinnati (UL1TR001425); Ohio Department of Health

Too Much Dietary Flexibility May Hinder, Not Help: Could More Specific Targets for Daily Food Intake Distribution Promote Glycemic Management among Youth with Type 1 Diabetes?

“…Full-text articles were assessed for eligibility (n = 211), which identified 17 experimental studies that included eating behavior as an exposure and glycemic management as an outcome, 31 observational studies that included adjusted associations between eating behavior and glycemic management, 7 relevant systematic reviews and meta-analyses, as well as 4 consensus guidelines. HbA1c in youth with T1D worsened in the US over the past decade despite concurrent increased uptake of self-management technology, underscoring the continued need for additional strategies to support glycemic management in this population [16][17][18].…”

“…Only ~14-17% of youth achieve HbA1c targets in settings with the most advanced diabetes technology [14,15]. Counterintuitively, average HbA1c in youth with T1D worsened in the US over the past decade despite concurrent increased uptake of self-management technology, underscoring the continued need for additional strategies to support glycemic management in this population [16][17][18].…”

Mindfulness, disordered eating, and impulsivity in relation to glycemia among adolescents with type 1 diabetes and suboptimal glycemia from the Flexible Lifestyles Empowering Change ( FLEX ) intervention trial

“…At the population level, measures of glycemia among U.S. adolescents with type 1 diabetes (T1D) have not improved in the past two decades, despite substantial treatment and technological advances. [1][2][3] Suboptimal glycemia among adolescents with T1D (defined in various studies as a hemoglobin A1c [HbA1c] ≥9%) 4,5 is a major risk factor for both acute, life-threatening complications, 6 and future micro- 7 and macrovascular disease. 5,8 The burden of diabetes management is associated with an increased prevalence of disordered eating behaviors (DEBs), 9 diabetes distress, 10 and other mental health comorbidities, 11,12 which may contribute to adolescents with T1D not meeting glycemic targets.…”

“…At the population level, measures of glycemia among U.S. adolescents with type 1 diabetes (T1D) have not improved in the past two decades, despite substantial treatment and technological advances 1–3 . Suboptimal glycemia among adolescents with T1D (defined in various studies as a hemoglobin A1c [HbA1c] ≥9%) 4,5 is a major risk factor for both acute, life‐threatening complications, 6 and future micro‐ 7 and macrovascular disease 5,8 .…”

“…The analyses were adjusted for multiple potential confounding variables, including randomization assignment to the FLEX intervention group, to reduce confounding bias in our estimation of the mindfulness-glycemia relationship. The use of mixed models with data from multiple timepoints for the outcome of HbA1c allowed us to establish temporality in the relationship between mindfulness and HbA1c.It is especially critical to design novel intervention studies targeting glycemia, in light of recent findings from the SEARCH for Diabetes inYouth study which highlight a lack of population-level improvements to HbA1c over the past two decades among youth with T1D 2,73. The present study suggests that heightened mindfulness in the context of T1D may be an important component of improving glycemic levels in adolescents.…”