Characteristics of newly diagnosed adults with type 1 diabetes in the UK and evolution of glycaemic control, body mass index and Charlson comorbidity index over the first 5 years after diagnosis

Abstract

Aims: This retrospective, longitudinal study characterised 2430 adults (mean age 40.8 ± 16.1 years) with newly diagnosed type 1 diabetes (T1D) over the first 5 years of insulin treatment. Methods: Data from 1 year pre-and up to 5 years post-insulin initiation were extracted from the UK Clinical Practice Research Datalink (1990-2013). Baseline HbA 1c , BMI and Charlson comorbidity index (CCI) score were compared with data at 1, 2, 3 and 5 years. Results: Mean HbA 1c decreased significantly from baseline 95 ± 32.8 mmol/mol (10.8 ± 3.0%) to 61 ± 21.9 mmol/mol (7.7 ± 2.0%) at 1 year, remaining significantly lower at 2, 3 and 5 years (p < 0.0001). One year after initiating insulin, only 6.3% of patients had HbA 1c <48 mmol/mol (<6.5%). There was no further improvement in HbA1c after 1 year. Mean BMI increased significantly from baseline 25.3 ± 5.5 kg/m 2 to 27.2 ± 5.8 kg/m 2 at 1 year; p < 0.0001), remaining significantly higher thereafter, with over two-thirds having overweight/obesity by year 5. Mean CCI score increased significantly (1.32, baseline; 1.46, year 1; 1.75, year 5). CCI patterns were similar within BMI and HbA 1c strata. Conclusions: More intensive support to reach and maintain glycaemic targets soon postdiagnosis, while avoiding weight gain, and prevention and optimal management of comorbidities are warranted.

Distinguishing between type 1 and type 2 diabetes

“…While hyperglycaemia in adults is often associated with type 2 diabetes, 40% of type 1 diabetes cases occur in people over 30 8. Indeed, in a retrospective longitudinal study of more than 2000 adults with newly diagnosed type 1 diabetes, the mean age of presentation was 40, mean BMI was 25.3 kg/m 2 , and mean blood glucose reading was 16.7 mmol/L (300 mg/dL) 5. Hence, distinguishing type 1 from type 2 diabetes3 can be particularly difficult in…”

Nutritional Therapy for Athletes with Diabetes

“…T1D subjects usually present with a morphotype incline to normal weight, thus not needing caloric restrictions but with a high susceptibility to hypoglycemia compared to individuals with T2D [ 29 ]. The objectives of nutritional treatment must provide an adequate caloric intake to treat hypoglycemia in the short and long term.…”

“…The objectives of nutritional treatment must provide an adequate caloric intake to treat hypoglycemia in the short and long term. Diet must be designed on the subject and his/her caloric needs in accordance with the sport practiced [ 29 ].…”

“…The American Diabetes Association (ADA) suggested a diet based on a flexible percentage of CHO, which can vary from 45 to 55% of total calorie intake [ 25 , 29 , 30 , 31 ]. Several studies have shown that saccharose intake does not increase glycemic levels more than starch [ 32 ], even though the consumption of low glycemic index (GI) food can reduce postprandial glycemia [ 25 , 33 ].…”

Description of a Cohort of Type 1 Diabetes Patients: Analysis of Comorbidities, Prevalence of Complications and Risk of Hypoglycemia

“…Despite this progress, T1D patients still have greater morbidity and mortality than the general population [9,10]. This could be explained by the fact that even with better therapeutic tools and educational resources, glycemic control remains suboptimal in most patients [11]. However, even supposedly well-controlled T1D patients without other cardiovascular risk factors follow the same trend, thus pointing to the existence of other possible risk factors or mechanisms involved.…”