Clinical outcomes in youth beyond the first year of type 1 diabetes: Results of the Pediatric Diabetes Consortium (PDC) type 1 diabetes new onset (NeOn) study

Abstract

Objective Current data are limited on the course of type 1 diabetes (T1D) in children and adolescents through the first few years of diabetes. The Pediatric Diabetes Consortium T1D New Onset (NeOn) Study was undertaken to prospectively assess natural history and clinical outcomes in children treated at 7 US diabetes centers from the time of diagnosis. This paper describes clinical outcomes in the T1D NeOn cohort during the first 3 years post-diagnosis. Results 1048 participants (mean age 9.2 years, 49% female, 65% non-Hispanic White) were enrolled between July 2009 and April 2011. Mean HbA1c (±SD) was 7.2% (55 mmol/mol) at 3 months, followed by a progressive rise to 8.4% (68 mmol/mol) at 36 months post-diagnosis, with only 30% of participants achieving target HbA1c<7.5% (58 mmol/mol). The percentage of participants in partial remission estimated by insulin dose adjusted HbA1c [HbA1c % + (4 × insulin dose unit/kg/24 h)] ≤9 sharply declined from 23% at 12 months to 7% at 36 months. The percentage of participants developing diabetic ketoacidosis (DKA) was 1% in the first year after diagnosis, increasing to 6% in year 2 and year 3. Conclusions These results demonstrate the gradual decline in glycemic control due to waning residual endogenous insulin secretion with increasing duration of T1D in children and adolescents. These data indicate the need to translate recent advances in automated insulin delivery, new insulin analogs and adjunctive pharmacologic agents into novel treatment strategies to maintain optimal glycemic control even early in the course of T1D.

Partial remission in type 1 diabetes and associated factors: Analysis based on the insulin dose‐adjusted hemoglobin A1c in children and adolescents from a regional diabetes center, Auckland, New Zealand

“…Over time, there was a progressive reduction in the number of children and adolescents in PREM, with the lowest rate detected 18 months after disease onset (7%). Similarly to our findings, Cengiz et al observed a sharp decline in PREM rates with increasing duration of disease (from 23% at 12 months down to 7% at 36 months in youth with T1D). These data are likely to reflect the natural history of the PREM phase, during which the surviving β‐cell function initially results in a more optimal metabolic control phase, with the lowest HbA1c detected during the first 6 months after T1D onset .…”

“…Similarly to our findings, Cengiz et al observed a sharp decline in PREM rates with increasing duration of disease (from 23% at 12 months down to 7% at 36 months in youth with T1D). These data are likely to reflect the natural history of the PREM phase, during which the surviving β‐cell function initially results in a more optimal metabolic control phase, with the lowest HbA1c detected during the first 6 months after T1D onset . However, there is a subsequent functional decline in β‐cells reserve, leading to a progressive deterioration of diabetes control .…”

Persistent heterogeneity in diabetes technology reimbursement for children with type 1 diabetes: The SWEET perspective

“…Intensive insulin treatment improves glycemic control and reduces the risk for acute and long‐term complications. The use of insulin analogs allows children to improve glycemic control with more flexibility in their daily lives, reducing the risk of nocturnal hypoglycemia and postprandial hyperglycemia compared to human regular and intermediate acting insulins . The current report shows a generally satisfactory reimbursement of all types of insulin in Europe for children with T1D, which illustrates the positive trend in insulin reimbursement in the last decade.…”

“…To provide intensive insulin therapy, regular self‐monitoring of glucose is essential for effective diabetes management . A greater frequency of finger prick glucose monitoring improves diabetes control due to better insulin dosing for meals and corrections of out‐of‐target glucose values.…”

“…The last year was extremely turbulent with respect to availability and To provide intensive insulin therapy, regular self-monitoring of glucose is essential for effective diabetes management. 7 Insulin pump therapy has been used safely and effectively in pediatric populations for the last three decades. 6 Particularly beneficial is CSII treatment in pre-school aged children.…”