Decreasing Trends in Mean HbA1c Are Not Associated With Increasing Rates of Severe Hypoglycemia in Children: A Longitudinal Analysis of Two Contemporary Population-Based Pediatric Type 1 Diabetes Registries From Australia and Germany/Austria Between 1995 and 2016

Haynes, Aveni; Hermann, Julia; Clapin, Helen; Hofer, Sabine E.; Karges, Beate; Jones, Timothy W.; Davis, Elizabeth A.; Holl, Reinhard W.

doi:10.2337/dc18-2448

Cited by 40 publications

(36 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The frequency of SH was similar in both treatment groups and seemed to be comparable to reported in other studies 33–35 . In recent years, the rates of SH in T1D have been found to follow a decreasing trend, mostly due to new technologies' use 36 . In the present study, CGM‐users experienced a slightly increased rate of SH, which stands in contrast to the similar reports 27,37 .…”

Section: Discussionsupporting

confidence: 89%

Above 40% of Polish children and young adults with type 1 diabetes achieve international HbA1c target ‐ results of a nationwide cross‐sectional evaluation of glycemic control: The PolPeDiab HbA1c study

et al. 2021

View full text Add to dashboard Cite

Background Youth with type 1 diabetes (T1D) (16–18 y.o.) present worst disease control of all age groups and need structured interventions. Those should be based on unbiased, national‐scale outcomes, which have not yet been successfully assessed in Poland. Objective To evaluate the glycemic control in young patients with T1D in Poland. Method All pediatric diabetes care centers and the nine largest centers for adults with T1D were invited to this cross‐sectional study, conducted in March 2018. Eligibility was defined as age ≤ 30 years and diabetes duration ≥1 year. Blinded samples of capillary blood and clinical questionnaires were sent to coordinating center, where HbA1c was measured by high‐pressure liquid chromatography. Results Nine adult and 25/28 pediatric centers participated, providing data for 1255 patients (50.8% males), mean age 12.3 years (95%CI:12.1–12.6) for children and 23.2 years (22.9–23.6) for adults; mean diabetes duration 7.1 years (6.8–7.3). This covered ~8% of pediatric population and 2% of 18–30‐years‐olds with T1D. Mean HbA1c was comparable between children and adults (57 mmol/mol [7.4%], 95%CI:56‐57 mmol/mol [7.3–7.4%] vs. 57 mmol/mol [7.4%], 95%CI:56–60 mmol/mol [7.3–7.6%], p = 0.1870). Overall, 45.2% of patients achieved ISPAD target (<53 mmol/mol [<7.0%]). During the month preceding the study, 0.9% of patients experienced severe hypoglycemia and 0.4% suffered ketoacidosis. HbA1c was related to the method of insulin therapy, continuous glucose monitoring use and body weight (p < 0.0001). Conclusions In Polish children and young adults with T1D glycemic control expressed as HbA1c is promising in the light of ISPAD guidelines. Our results confirm the known associations between better glycemic control and the use of new technologies and maintaining optimal body weight.

show abstract

Section: Discussionsupporting

confidence: 89%

Above 40% of Polish children and young adults with type 1 diabetes achieve international HbA1c target ‐ results of a nationwide cross‐sectional evaluation of glycemic control: The PolPeDiab HbA1c study

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Two studies found presence of severe hypoglycaemia to be associated with higher BMIz 9,17 . Two multicentre studies investigated the relationship between HbA 1c and severe hypoglycaemia and found no association overall 27,28 . In Denmark the rate of severe hypoglycaemic events has been decreasing during the past decade to <5 events per 100 person years, 14 and we hypothesized that hypoglycaemia would explain some of the association between HbA 1c and BMI, because intensified treatment and fear of hypoglycaemia could lead to increasing intake of carbohydrates when blood glucose is low.…”

Section: Discussionmentioning

confidence: 95%

Association between glycaemic outcome and BMI in Danish children with type 1 diabetes in 2000–2018: a nationwide population‐based study

et al. 2020

View full text Add to dashboard Cite

Aim To describe the development of HbA1c and BMI over time in Danish children with type 1 diabetes; and to investigate the association between HbA1c and BMI including influence of age, gender, diabetes duration, severe hypoglycaemia and treatment method. Methods We used the nationwide Danish Registry of Childhood and Adolescent Diabetes, DanDiabKids, including annual registrations of all children with diabetes treated at Danish hospitals. With linear mixed‐effects models and splines we analyzed the HbA1c and BMI development over time as well as the association between HbA1c and BMI including effects of gender, age, disease duration, hypoglycaemia and treatment method. BMI z‐scores were calculated for these analyses. Results For the period from 2000 to 2018, 6097 children with type 1 diabetes were identified from the DanDiabKids database. The median (interquartile range) HbA1c level was 65 (57–74) mmol/mol (8.1%) and the median BMI z‐score was 0.85 in girls and 0.67 in boys. A non‐linear association was found between HbA1c and BMI z‐score, with the highest BMI z‐score observed for HbA1c values in the range of approximately 60–70 mmol/mol (7.6–6.8%). The association was modified by gender, age and diabetes duration. Severe hypoglycaemia and insulin pump treatment had a small positive impact on BMI z‐score. Conclusion The association between HbA1c and BMI z‐score was non‐linear, with the highest BMI z‐score being observed for intermediate HbA1c levels; however, specific patterns depended on gender, age and diabetes duration.

show abstract

“…A more recently analysis of the DPV and WACDD cohorts confirmed the decreases in A1C and severe hypoglycemia rate and found similarly low severe hypoglycemia rates in all A1C categories ( Fig. 2 ) ( 31 ). Similarly, in a study ( 34 ) of 1,770 children (<16 years of age) followed between 2000 and 2011, those with A1C <7% did not have higher rates of hypoglycemia compared with children with A1C 8–9%.…”

Section: Evidence Of Decrease In Hypoglycemia Risk—an Evolution Since...mentioning

confidence: 62%

“…The Danish Adult Diabetes Database (DADD) documented an annual decrease of 8.4% in the incidence rate of severe hypoglycemia ( 30 ). An analysis of temporal trends in children diagnosed with T1D <15 years of age from 1995 to 2016 from the longitudinal, prospective, population-based German/Austrian Diabetes Patient History Documentation (Diabetes Patienten Verlaufsdokumenation, DPV) ( N = 59,883) and Western Australian Children's Diabetes Database (WACDD) ( N = 2,595) diabetes registries demonstrated concurrent improvements in A1C and decreasing severe hypoglycemia rates ( 31 ) between 1995 and 2016. The relationship of A1C and severe hypoglycemia has also changed in the 27 years that have elapsed since the DCCT report.…”

Section: Evidence Of Decrease In Hypoglycemia Risk—an Evolution Since...mentioning

confidence: 99%

“… A1C and rates of severe hypoglycemia, adjusted for sex, age at diagnosis, and diabetes duration, observed in the longitudinal, prospective DPV (German-Austrian) and WACDD (Austrialian) cohorts since 1991 ( 31 ). The rates of severe hypoglycemia (SH) decreased since 1991 and were similar across A1C groups (i.e., <7.5%, 7.5 to <8.5%, and ≥8.5%), particularly in the last time period (2012–2016).…”

Section: Evidence Of Decrease In Hypoglycemia Risk—an Evolution Since...mentioning

confidence: 99%

See 1 more Smart Citation

The Evolution of Hemoglobin A1c Targets for Youth With Type 1 Diabetes: Rationale and Supporting Evidence

et al. 2021

View full text Add to dashboard Cite

The American Diabetes Association 2020 Standards of Medical Care in Diabetes (Standards of Care) recommends a hemoglobin A1c (A1C) of <7% (53 mmol/mol) for many children with type 1 diabetes (T1D), with an emphasis on target personalization. A higher A1C target of <7.5% may be more suitable for youth who cannot articulate symptoms of hypoglycemia or have hypoglycemia unawareness and for those who do not have access to analog insulins or advanced diabetes technologies or who cannot monitor blood glucose regularly. Even less stringent A1C targets (e.g., <8%) may be warranted for children with a history of severe hypoglycemia, severe morbidities, or short life expectancy. During the “honeymoon” period and in situations where lower mean glycemia is achievable without excessive hypoglycemia or reduced quality of life, an A1C <6.5% may be safe and effective. Here, we provide a historical perspective of A1C targets in pediatrics and highlight evidence demonstrating detrimental effects of hyperglycemia in children and adolescents, including increased likelihood of brain structure and neurocognitive abnormalities, microvascular and macrovascular complications, long-term effects, and increased mortality. We also review data supporting a decrease over time in overall severe hypoglycemia risk for youth with T1D, partly associated with the use of newer insulins and devices, and weakened association between lower A1C and severe hypoglycemia risk. We present common barriers to achieving glycemic targets in pediatric diabetes and discuss some strategies to address them. We aim to raise awareness within the community on Standards of Care updates that impact this crucial goal in pediatric diabetes management.

show abstract

Decreasing Trends in Mean HbA1c Are Not Associated With Increasing Rates of Severe Hypoglycemia in Children: A Longitudinal Analysis of Two Contemporary Population-Based Pediatric Type 1 Diabetes Registries From Australia and Germany/Austria Between 1995 and 2016

Cited by 40 publications

References 36 publications

Above 40% of Polish children and young adults with type 1 diabetes achieve international HbA1c target ‐ results of a nationwide cross‐sectional evaluation of glycemic control: The PolPeDiab HbA1c study

Above 40% of Polish children and young adults with type 1 diabetes achieve international HbA1c target ‐ results of a nationwide cross‐sectional evaluation of glycemic control: The PolPeDiab HbA1c study

Association between glycaemic outcome and BMI in Danish children with type 1 diabetes in 2000–2018: a nationwide population‐based study

The Evolution of Hemoglobin A1c Targets for Youth With Type 1 Diabetes: Rationale and Supporting Evidence

Contact Info

Product

Resources

About