Identification and prediction of group-based glycemic control trajectories during the transition to adolescence.

Abstract

Objective To identify trajectories of glycemic control over a period of three years in a pediatric sample of youth diagnosed with type 1 diabetes transitioning to adolescence. A second aim was to examine a set of modifiable individual and family-level baseline predictors of glycemic control group membership. Methods This multisite, prospective study included 239 children and adolescents (ages 9–11 years at baseline) diagnosed with type 1 diabetes and their caregivers. Glycemic control was based on hemoglobin A1c (HbA1c) collected at six month intervals over a period of three years. Predictors of glycemic control membership included baseline global executive functioning, diabetes self-management, diabetes-specific family conflict, blood glucose monitoring frequency, and relevant individual and family level covariates. Results Group-based trajectory analyses were used to describe patterns of glycemic control from baseline to 36 months and three trajectories were identified: low risk (42.9%), elevated risk (44.6%), and high risk (12.1%) subgroups. Baseline maternal-reported family conflict, blood glucose monitoring frequency, and gender were significant predictors of glycemic control group membership. Higher levels of baseline family conflict, lower frequency of blood glucose monitoring, and female gender were associated with elevated and high risk group membership. Conclusions These findings underscore the importance of examining trajectories of HbA1c across time. These results suggest that problematic trajectories of glycemic control are evident during the transition to adolescence. Furthermore, there are modifiable individual and family-level characteristics that predict group membership and hence could be targeted in interventions to ensure adequate glycemic control is maintained over time and that risks for diabetes-related complications are reduced.

Effects of Triple P parenting intervention on child health outcomes for childhood asthma and eczema: Randomised controlled trial

“…The theoretical and empirical literature provide compelling evidence that parenting plays a central role in children's health outcomes (Morawska, Calam, & Fraser, 2015;Wood et al, 2008); yet, current approaches to childhood illness management do not target parenting (Law et al, 2014). Parent and family factors impact on illness onset (Mrazek et al, 1999), and disease course (Rohan et al, 2014), and parents of chronically ill children engage in different parenting practices compared to parents of healthy children (Holmbeck et al, 2002;Pinquart, 2013b).…”

Predictors of changing insulin dose requirements and glycaemic control in children, adolescents and young adults with Type 1 diabetes

“…Optimizing glycaemic control substantially reduces the risk of microvascular and macrovascular complications [2,3]; however, achieving the recommended American Diabetes Association target levels of HbA 1c <58 mmol/mol (<7.5%) for individuals aged <18 years and <53 mmol/mol (<7%) for young adults remains a challenge [4,5]. In studies involving children and adolescents with Type 1 diabetes, poor glycaemic control has been associated with older age, black race and longer diabetes duration [6,7]; however, many studies analysing predictors of deterioration in glycaemic control during childhood and adolescence have been limited by short duration of follow-up [8,9], small sample size [10,11] and limited numbers of factors evaluated [10,12]. …”

Trajectories of Glycemic Change in a National Cohort of Adults With Previously Controlled Type 2 Diabetes

“…Furthermore, all patients had commercial insurance and thus access to healthcare, though different benefit designs may have placed some patients at greater financial burden than others. Our study dataset and models were further limited by absence of psychosocial information, which has been shown to be important in identifying glycemic trajectories in type 1 diabetes, 9–12 and may similarly contribute to glycemic patterns among adults with type 2 diabetes. Administrative data also does not capture lifestyle habits and weight changes, which can contribute to glycemic change.…”

“…9–12, 33 One study was conducted among adults with type 2 diabetes, but did not focus on controlled patients. 34 By applying a novel analytic framework to administrative and laboratory data from a large and diverse national cohort of adults with type 2 diabetes, our study allowed for data-driven identification of HbA 1c trajectories and discovery of potentially meaningful patient- and population-level risk factors that warrant further evaluation.…”