Longitudinal Trajectories of Metabolic Control From Childhood to Young Adulthood in Type 1 Diabetes From a Large German/Austrian Registry: A Group-Based Modeling Approach

Schwandt, Anke; Hermann, Julia; Rosenbauer, Joachim; Boettcher, Claudia; Dunstheimer, Desirée; Grulich‐Henn, Jürgen; Kuß, Oliver; Rami‐Merhar, Birgit; Vogel, Christian; Holl, Reinhard W.; Initiative, Dpv

doi:10.2337/dc16-1625

Cited by 85 publications

(144 citation statements)

References 37 publications

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“…A recent study analyzing data from the multicenter diabetes registry Diabetes‐Patienten‐Verlaufsdokumentation (DPV) identified five distinct longitudinal HbA1c trajectories from childhood (8 years) through to young adulthood (19 years) . Although the aim of this DPV study was not to compare injection and pump therapy but to identify trajectories; the results support the findings of our study.…”

Section: Discussionsupporting

confidence: 85%

Real‐world outcomes of insulin pump compared to injection therapy in a population‐based sample of children with type 1 diabetes

et al. 2018

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Section: Discussionsupporting

confidence: 85%

Real‐world outcomes of insulin pump compared to injection therapy in a population‐based sample of children with type 1 diabetes

et al. 2018

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“…Crucially, previous reports [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] have largely examined individuals with pre-existing type 1 diabetes (i.e. not from the time of diagnosis).…”

Section: Introductionmentioning

confidence: 99%

Clinically meaningful and lasting HbA1c improvement rarely occurs after 5 years of type 1 diabetes: an argument for early, targeted and aggressive intervention following diagnosis

et al. 2018

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Aims/hypothesis Our objectives were to explore whether the phenomenon of HbA 1c 'tracking' occurs in individuals with type 1 diabetes, how long after diagnosis does tracking take to stabilise, and whether there is an effect of sex and age at diagnosis on tracking. Methods A total of 4525 individuals diagnosed with type 1 diabetes between 1 January 1995 and 1 May 2015 were identified from The Health Improvement Network (THIN) database. Mixed models were applied to assess the variability of HbA 1c levels over time with random effects on general practices (primary care units) and individuals within practices. Results 4525 individuals diagnosed with type 1 diabetes were identified in THIN over the study period. The greatest difference in mean HbA 1c measurement (−7.0 [95% CI −8.0, −6.1] mmol/mol [0.6%]) was seen when comparing measurements made immediately after diagnosis (0-1 year since diagnosis) with those at 10 or more years (the reference category). The mean difference in HbA 1c for the successive periods compared with 10 or more years after diagnosis declined and was no longer statistically significant after 5 years. In the stratified analysis using sex and age group there was considerable heterogeneity with adult onset type 1 diabetes appearing to track earlier and at a lower mean HbA 1c . Conclusions/interpretation In individuals with type 1 diabetes, glycaemic control measured by HbA 1c settles onto a long-term 'track' and this occurs on average by 5 years following diagnosis. Age at diagnosis modifies both the rate at which individuals settle into their track and the absolute HbA 1c tracking level for the next 10 years.

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“…The amount of insulin needed to maintain glycemic control increases in puberty [6] and with longer T1D duration and older age [7]. The DCCT—Epidemiology of Diabetes Interventions and Complications (EDIC) study also demonstrated that increased insulin needs are associated with more T1D complications [8, 9] and weight gain and higher weight status across time in individuals with T1D [10–12, 13••] because of the anabolic and lipogenic actions of insulin [14].…”

Section: The Role Of Insulin In Weight Gainmentioning

confidence: 99%

Biopsychosocial Aspects of Weight Management in Type 1 Diabetes: a Review and Next Steps

et al. 2017

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Purpose of Review This review aims to summarize the type 1 diabetes (T1D) and weight literature with an emphasis on barriers associated with weight management, the unique T1D-specific factors that impact weight loss success, maladaptive and adaptive strategies for weight loss, and interventions to promote weight loss. Recent Findings Weight gain is associated with intensive insulin therapy. Overweight and obese weight status in individuals with T1D is higher than the general population and prevalence is rising. A variety of demographic (e.g., female sex), clinical (e.g., greater insulin needs), environmental (e.g., skipping meals), and psychosocial (e.g., depression, stress) factors are associated with overweight/obese weight status in T1D. Fear of hypoglycemia is a significant barrier to engagement in physical activity. Studies evaluating adaptive weight loss strategies in people with T1D are limited. Summary There is a growing literature highlighting the prevalence and seriousness of overweight and obesity among both youth and adults with T1D. There is an urgent need to develop evidence-based weight management guidelines and interventions that address the unique concerns of individuals with T1D and that concurrently address glycemic control.

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Longitudinal Trajectories of Metabolic Control From Childhood to Young Adulthood in Type 1 Diabetes From a Large German/Austrian Registry: A Group-Based Modeling Approach

Abstract: Using a trajectory approach, we determined five distinct longitudinal patterns of glycemic control from childhood to early adulthood. Diabetes self-care, treatment differences, and demographics were related to different HbA courses.

Cited by 85 publications

References 37 publications

Real‐world outcomes of insulin pump compared to injection therapy in a population‐based sample of children with type 1 diabetes

Real‐world outcomes of insulin pump compared to injection therapy in a population‐based sample of children with type 1 diabetes

Clinically meaningful and lasting HbA1c improvement rarely occurs after 5 years of type 1 diabetes: an argument for early, targeted and aggressive intervention following diagnosis

Biopsychosocial Aspects of Weight Management in Type 1 Diabetes: a Review and Next Steps

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