Trends in Glycemic Control Among Youth and Young Adults With Diabetes: The SEARCH for Diabetes in Youth Study

Abstract

OBJECTIVES To describe temporal trends and correlates of glycemic control in youth and young adults (YYA) with youth-onset diabetes. RESEARCH DESIGN AND METHODS The study included 6,369 participants with type 1 or type 2 diabetes from the SEARCH for Diabetes in Youth study. Participant visit data were categorized into time periods of 2002–2007, 2008–2013, and 2014–2019, diabetes durations of 1–4, 5–9, and ≥10 years, and age groups of 1–9, 10–14, 15–19, 20–24, and ≥25 years. Participants contributed one randomly selected data point to each duration and age group per time period. Multivariable regression models were used to test differences in hemoglobin A1c (HbA1c) over time by diabetes type. Models were adjusted for site, age, sex, race/ethnicity, household income, health insurance status, insulin regimen, and diabetes duration, overall and stratified for each diabetes duration and age group. RESULTS Adjusted mean HbA1c for the 2014–2019 cohort of YYA with type 1 diabetes was 8.8 ± 0.04%. YYA with type 1 diabetes in the 10–14-, 15–19-, and 20–24-year-old age groups from the 2014–2019 cohort had worse glycemic control than the 2002–2007 cohort. Race/ethnicity, household income, and treatment regimen predicted differences in glycemic control in participants with type 1 diabetes from the 2014–2019 cohort. Adjusted mean HbA1c was 8.6 ± 0.12% for 2014–2019 YYA with type 2 diabetes. Participants aged ≥25 years with type 2 diabetes had worse glycemic control relative to the 2008–2013 cohort. Only treatment regimen was associated with differences in glycemic control in participants with type 2 diabetes. CONCLUSIONS Despite advances in diabetes technologies, medications, and dissemination of more aggressive glycemic targets, many current YYA are less likely to achieve desired glycemic control relative to earlier cohorts.

In Vitro Inhibitory Activity and Molecular Docking Study of Selected Natural Phenolic Compounds as AR and SDH Inhibitors**

“…The likelihood of acquiring severe diabetic complications in DM is decreased by therapies such as intensive insulin therapy that strictly and consistently limit glucose excursions [7] . Tight control of blood glucose levels is challenging to maintain [8] . Hence research has been done to develop new, powerful anti‐diabetic medications that work through several methods [9] .…”

“…[7] Tight control of blood glucose levels is challenging to maintain. [8] Hence research has been done to develop new, powerful anti-diabetic medications that work through several methods. [9] Because aldose reductase (EC 1.1.1.21; AR, ALR2) [10] inhibitors (ARIs) do not affect plasma glucose, [11] they pose no danger of hypoglycemia and may be able to stop or slow the course of specific diabetic problems despite high blood sugar levels (Figure 1).…”

Trends in Glycemia between 2002 and 2016 among Incident Youth Cohorts Early in the Course of Type 1 Diabetes: The SEARCH for Diabetes in Youth Study

“…Glycemia has not improved among youth with longstanding T1D despite advancements in diabetes technologies [7]-nearly one-third to one-half have an HbA1c ≥ 9:5% (80 mmol/mol) [5,8]. Glycemia proximal to T1D diagnosis is also critical to manage given that a metabolic memory may persist beyond the period of initial diagnosis to influence future risk of diabetes-related complications [9].…”

Psychosocial Impact of the COVID-19 Pandemic in Racially/Ethnically Diverse Youth With Diabetes

“…Management of pediatric diabetes is complex, with high rates of youth experiencing elevated blood glucose levels far above recommended glycemic targets; the SEARCH for Diabetes in Youth Study ( Petitti et al, 2009 ) found 17% of youth with T1D and 27% of youth with type 2 diabetes (T2D) had Hemoglobin A1c (HbA1c) levels ≥9.5% and these trends are worsening in youth and young adults ( Malik et al, 2022 ). In addition, since youth with T2D are often treated with insulin therapy and glucose monitoring, they have a similar burden of diabetes management as youth with T1D ( American Diabetes Association Professional Practice Committee et al, 2022 ).…”