Effect of early glycemic control on HbA1c tracking and development of vascular complications after 5 years of childhood onset type 1 diabetes: Systematic review and meta‐analysis

Abstract

Objective A systematic review and meta‐analysis was conducted to investigate if glycemic control measured by glycated hemoglobin (HbA1c) levels near diagnosis are predictive of future glycemic outcomes and vascular complications in childhood onset type 1 diabetes (T1D). Methods Evidence was gathered using electronic databases (MEDLINE, EMBASE, Web of Science, CINAHL, Scopus, and Cochrane Library up to February 2017) and snowballing techniques. Studies investigating the association between the exposure “early glycemic control” and main outcome: “tracking of early control” and secondary outcome: risk of future complications; in children and young people aged 0 to 19 years at baseline; were systematically double‐reviewed, quality assessed, and outcome data extracted for synthesis and meta‐analysis. Findings Five studies (N = 4227 participants) were eligible. HbA1c levels were sub‐optimal throughout the study period but tended to stabilize in a “track” by 6 months after T1D diagnosis. The group with low HbA1c <53 mmol/mol (<7%) at baseline had lower long‐term HbA1c levels than the higher HbA1c group. The estimated standardized mean difference between the sub groups showed a reduction of HbA1c levels on average by 1.6% (range −0.95% to −2.28%) from baseline. Only one study investigated the association between early glycemic control and development of vascular complications in childhood onset T1D. Interpretations Glycemic control after the first few months of childhood onset T1D, remains stable but sub‐optimal for a decade. The low and high HbA1c levels at baseline seem to “track” in their respective tracks during the 10‐year follow‐up, however, the initial difference between groups narrows over time. PROSPERO: CRD42015024546 http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015024546

Continuous Glucose and Heart Rate Monitoring in Young People with Type 1 Diabetes: An Exploratory Study about Perspectives in Nocturnal Hypoglycemia Detection

“…A reduction in the incidence and progression of diabetes-related complications is associated with tight glycemic control [ 20 , 21 ]; nevertheless, the improvement of glycemic control increased the risk of iatrogenic hypoglycemia [ 1 , 2 , 3 , 4 ]. The main part of excess mortality in T1D is related to long-term complications; however, an excess death rate has also been reported in subjects with short disease duration and without long-term adverse effects [ 22 , 23 , 24 ].…”

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“…DKA prevention at diagnosis has potential lifelong benefits, including avoidance of acute morbidity (cerebral oedema, shock), neurocognitive impairment, and mortality 40,41 . There are also non‐causal associations between DKA at onset and future risk of DKA, 38,42 severe hypoglycemia 42 and long‐term hyperglycemia 43–45 which increases the risk of serious future diabetes‐related complications 46 . Furthermore, parental anxiety at diagnosis is approximately halved for children in screening programs compared to the general community 3 .…”

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“…Eine gute metabolische Einstellung von Beginn an ist prognostisch essentiell [33][34][35] daher ist es notwendig, eine individualisierte, alters-adäquate Therapie anzuwenden, um eine hohe Therapiezufriedenheit und Compliance zu erreichen.…”