A1C in Children and Adolescents With Diabetes in Relation to Certain Clinical Parameters

Abstract

OBJECTIVE—We explored the relationship between A1C and insulin regimen, duration of diabetes, age, sex, and BMI as well as the differences between clinical mean A1C levels at pediatric diabetes clinics in Sweden. RESEARCH DESIGN AND METHODS—Data from 18,651 clinical outpatient visits (1,033 girls and 1,147 boys) at 20 pediatric clinics during 2001 and 2002 registered in the Swedish Childhood Diabetes Registry SWEDIABKIDS, a national quality registry, were analyzed. RESULTS—A1C was <7.0% (target value ∼8% per Diabetes Control and Complications Trial/National Glycohemoglobin Standardization Program standards) at 35% of the visits. Girls had significantly higher mean A1C than boys during adolescence. High mean A1C was correlated with high mean insulin dose, long duration of diabetes, and older age. Mean A1C varied between clinics (6.8–8.2%). Differences between centers could not be explained by differences in diabetes duration, age, BMI, or insulin dose. CONCLUSIONS—Adolescents with a high insulin dose and a long duration of diabetes, especially girls, need to be focused on. Differences in mean values between centers remained inexplicable and require further investigation.

Glycated haemoglobin variations in paediatric type 1 diabetes: the impact of season, gender and age

“…Children and adolescents with type 1 diabetes in Sweden are intensively treated with multiple insulin injections or insulin pump therapy and active self-control. Their glycaemic control is better than, or comparable to, other populations (13,24,25). Perhaps this intense treatment can help these patients to handle the stress of the colder Swedish climate, and more infections during the winter, and equalise the HbA1c values over the year.…”

“…Girls aged between six and 12-years-of-age years of age were found to have higher HbA1c levels at diagnosis than boys of the same age and girls of other age groups (12). Moreover, poorer metabolic control has been found in girls than boys during the clinical course, especially during adolescence (13)(14)(15).…”

“…HbA1c values between the clinics in Sweden and these are not explained by clinical variables (13). The latest annual report from the registry, based on data from 2011, shows a difference of 1.3% (14.2 mmol/mol) (18).…”

Teenagers with poor metabolic control already have a higher risk of microvascular complications as young adults

“…Previous studies (2,3) have shown that improved glycaemic control, measured as HbA1c, is important in preventing, delaying or slowing the progression of long-term complications. A high proportion of adolescents do not reach treatment targets for glycated haemoglobin, HbA1c (4)(5)(6), and there is evidence that metabolic control deteriorates during adolescence. There is a correlation between metabolic control in late childhood and during adolescence (7)(8)(9).…”

Predictors of Glycemic Control in Children and Adolescents with Type 1 Diabetes in Southwestern Ontario

“…However, optimal glycemic control is difficult to achieve in the 'real-world'. Observational population-based studies have indicated suboptimal levels of glycemic control worldwide despite the well-publicized results of the DCCT (Petitti et al, 2009;Johannesen et al, 2008;Hanberger et al, 2008;Gerstl et al, 2007).…”