National trends in hyperglycaemia and diabetic ketoacidosis in children, adolescents and young adults with type 1 diabetes. A challenge due to age, stage of development or is new thinking of service provision needed?

Abstract

<p> </p> <p><strong>Objective</strong></p> <p>Adolescence is associated with high risk hyperglycaemia. This study examines the phenomenon in a life-course context. </p> <p><strong>Research design and methods</strong></p> <p>93,125 people with type 1 diabetes aged 5-30 years were identified from the National Diabetes Audit (NDA) and/or the National Paediatric Diabetes Audit (NPDA) for England and Wales for 2017/18-2019/20. For each audit year the latest HbA1c and hospital admissions for diabetic ketoacidosis (DKA) were identified. Data were analysed in sequential cohorts by year of age. </p> <p><strong>Results </strong></p> <p>In childhood, unreported HbA1c measurement was uncommon but by 19 years had increased to 22.3% for males and 17.3% for females, reducing to 17.9% and 13.1% respectively by 30 years. Median HbA1c at 9 years was 7.6% (60mmol/mol) (IQR 7.1%-8.4%, 54-68mmol/mol) in males and 7.7% (61mmol/mol) (8.0%-8.4%, 64-68mmol/mol) in females increasing to 8.7% (72mmol/mol) (7.5%-10.3%, 59-89mmol/mol) and 8.9% (74mmol/mol) (7.7%-10.6%, 61-92mmol/mol) respectively at 19 years before falling to 8.4% (68mmol/mol) (7.4%-9.7%, 57-83mmol/mol) and 8.2% (66mmol/mol) (7.3%-9.7%, 56-82mmol/mol) respectively at 30 years. Annual hospitalisation for DKA rose steadily from 6 years (2.0% for males, 1.4% for females) to peak at 19 years for males (7.9%) and 18 years for females (12.7%) reducing to 4.3% for males and 5.4% for females at 30 years. At all ages over 9 years the prevalence of DKA was higher in females. </p> <p><strong>Conclusions</strong></p> <p>HbA1c and the prevalence of DKA increase through adolescence and then decline. Measurement of HbA1c, a marker of clinical review, falls abruptly in the late teenage years. Age-appropriate services are needed to overcome these issues.</p>