Acta Diabetologica

, Volume 49, Issue 5, pp 355–362 | Cite as

Which factors predict glycemic control in children diagnosed with type 1 diabetes before 6.5 years of age?

Original Article

Abstract

Predictors of long-term glycemic control and growth patterns in children diagnosed with type 1 diabetes (T1D) before 6.5 years of age were evaluated. One hundred seventy-three children (84 boys) with a mean diabetes duration of 4.9 ± 2.8 years participated in this observational study. Medical charts were reviewed for background, disease- and treatment-related parameters, and growth parameters. Study endpoints were HbA1c value, rates of severe hypoglycemia and diabetic ketoacidosis events, and growth patterns. Mean HbA1c for the total duration of diabetes (HbA1c–TDD) was 7.9 ± 0.8%. Comparison of the study variables between patients with HbA1c–TDD <7.5% (n = 53) or ≥7.5% yielded a significantly shorter duration of diabetes (P = 0.01) and lower rate of diabetic ketoacidosis (P = 0.02) in those with HbA1C–TDD <7.5%, without differences between these groups in age at diabetes onset, insulin regimens, daily glucose measurements, and rate of severe hypoglycemia. Factors significantly predicting achievement of the mean target HbA1c–TDD <7.5% were lower HbA1c at 0.5 years and 1 year after diabetes diagnosis (P = 0.002 and P < 0.001, respectively). Patients followed for at least 5 years (n = 48) showed a significant decrease in height-SDS (P < 0.001) and a significant increase in weight-SDS (P = 0.004) from diabetes diagnosis to the last follow-up visit, without a significant change in weight-SDS from 0.5 years after diagnosis to the last follow-up visit. Our results suggest that in patients with T1D diagnosed during the preschool-age, mean HbA1c level in the first year is a strong predictor of achieving target HbA1c level in the subsequent years, regardless the type of insulin regimen. This “metabolic tracking” emphasizes the importance of achieving early optimal control even in younger children.

Keywords

Type 1 diabetes Glycemic control Growth 

Supplementary material

592_2011_321_MOESM1_ESM.doc (45 kb)
Supplementary material 1 (DOC 45 kb)

References

  1. 1.
    Patterson CC, Dahlquist GG, Gyurus E, Green A, Soltesz G (2009) Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–20: a multicentre prospective registration study. Lancet 373:2027–2033PubMedCrossRefGoogle Scholar
  2. 2.
    Torres-Avilés F, Carrasco E, Icaza G, Pérez-Bravo F (2010) Clustering of cases of type 1 diabetes in high socioeconomic communes in Santiago de Chile: spatio-temporal and geographical analysis. Acta Diabetol 47(3):251–257PubMedCrossRefGoogle Scholar
  3. 3.
    Jarosz-Chobot P, Deja G, Polanska J (2010) Epidemiology of type 1 diabetes among Silesian children aged 0–14 years, 1989–2005. Acta Diabetol 47(1):29–33PubMedCrossRefGoogle Scholar
  4. 4.
    Lumey LH (2000) Variation and trends in the incidence of childhood diabetes in Europe: EURODIAB ACE Study Group. Lancet 355:873–876CrossRefGoogle Scholar
  5. 5.
    Silverstein J, Malone IJ (2000) Strict glycemic control is necessary but not practical in most children with type 1 diabetes. J Clin Endocrinol Metab 85:2518–2522CrossRefGoogle Scholar
  6. 6.
    Ryan CM, Becker DJ (1999) Hypoglycemia in children with type 1 diabetes mellitus: risk factors, cognitive function, and management. Endocrinol Metab Clin North Am 28:883–900PubMedCrossRefGoogle Scholar
  7. 7.
    Svensson M, Eriksson JW, Dahlquist G (2004) Early glycemic control, age at onset, and development of microvascular complications in childhood- onset type 1 diabetes: a population-based study in northern Sweden. Diabetes Care 27:955–962PubMedCrossRefGoogle Scholar
  8. 8.
    Diabetes Control and Complications Trial Research Group (1993) The effect of intensive insulin treatment of diabetes on the development and progression of long term complications on insulin dependent diabetes mellitus. N Engl J Med 329:977–985CrossRefGoogle Scholar
  9. 9.
    Du Caju MVL, Rooman RP, De Beek LO (1995) Longitudinal data on growth and final height in diabetic children. Pediatr Res 38:607–611PubMedCrossRefGoogle Scholar
  10. 10.
    Rudolf MCJ, Shewin RS, Markowitz R, Bates SE, Genel M, Hochstadt J, Tamborlane WV (1982) Effect of intensive insulin treatment on linear growth in the young diabetic patient. J Pediatr 101:333–339PubMedCrossRefGoogle Scholar
  11. 11.
    Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R, Curtin LR, Roche AF, Johnson CL (2002) CDC growth charts for the United States: methods and development. Vital Health Stat 11 246:1–190PubMedGoogle Scholar
  12. 12.
    Rewers M, Pihoker C, Donaghue K, Hanas R, Swift P, Klingensmith GJ (2007) Assessment and monitoring of glycemic control in children and adolescents with diabetes. Pediatr Diabetes 8:408–418PubMedCrossRefGoogle Scholar
  13. 13.
    Dixon WJ (1993) BMDP statistical software. University of California Press, BerkeleyGoogle Scholar
  14. 14.
    Rosilio M, Cotton JB, Wieliczko MC, Gendrault B, Carel JC, Couvaras O, Ser N, Bougnères PF, Gillet P, Soskin S, Garandeau P, Stuckens C, Le luyer B, Jos J, Bony-Trifunovic H, Bertrand AM, Leturcq F, Lafuma A (1998) Factors associated with glycemic control. A cross-sectional nationwide study in 2,579 French children with type 1 diabetes. Diabetes Care 21(7):1146–1153PubMedCrossRefGoogle Scholar
  15. 15.
    Sulmont V, Souchon P-F, Gouillard-Darnaud C, Fartura A, Salmon-Musial AS, Lambrecht E, Mauran P, Abely M (2010) Metabolic control in children with diabetes mellitus who are younger than 6 years at diagnosis: continuous subcutaneous insulin infusion as a first line treatment? J Pediatr 157:103–107PubMedCrossRefGoogle Scholar
  16. 16.
    Weinzimer SA, Ahern JH, Doyle EA, Vincent MR, Dziura J, Steffen AT, Tamborlan WV (2004) Persistence of benefits of continuous subcutaneous insulin infusion in very young children with type 1 diabetes: a follow-up report. Pediatrics 114:1601–1605PubMedCrossRefGoogle Scholar
  17. 17.
    Silverstein J, Klingensmith G, Copeland K, Plotnick L, Kaufman F, Laffel L, Deeb L, Grey M, Anderson B, Holzmeister LA, Clark N, American Diabetes Association (2005) Care of children and adolescents with type 1 diabetes: a statement of the American Diabetes Association. Diabetes Care 28:186–212PubMedCrossRefGoogle Scholar
  18. 18.
    Haller MJ, Stalvey MS, Silverstein JH (2004) Predictors of control of diabetes: monitoring may be the key. J Pediatr 144:660–661PubMedCrossRefGoogle Scholar
  19. 19.
    Levine BS, Anderson BJ, Butler DA, Antisdel JE, Brackett J, Laffel LMB (2001) Predictors of glycemic control and short-term adverse outcomes in youth with type 1 diabetes. J Pediatr 139:197–203PubMedCrossRefGoogle Scholar
  20. 20.
    Shalitin S, Gil M, Nimri R, de Vries L, Gavan MY, Phillip M (2010) Predictors of glycaemic control in patients with type 1 diabetes commencing continuous subcutaneous insulin infusion therapy. Diabet Med 27(3):339–347PubMedCrossRefGoogle Scholar
  21. 21.
    Ludvigsson J, Heding LG, Larsson Y, Leander E (1977) C-peptide in juvenile diabetics beyond the postinitial remission period. Relation to clinical manifestations at onset of diabetes, remission and diabetic control. Acta Paediatr Scand 66(2):177–184PubMedCrossRefGoogle Scholar
  22. 22.
    Edge JA, James T, Shine B (2010) Persistent individual tracking within overall improvement in HbA1c in a UK paediatric diabetes clinic over 15 years. Diabet Med 27:1284–1288PubMedCrossRefGoogle Scholar
  23. 23.
    Thompson SJ, Auslander WF, White NH (2001) Comparison of single-mother and two-parent families on metabolic control of children with diabetes. Diabetes Care 24:234–238PubMedCrossRefGoogle Scholar
  24. 24.
    Doyle EA, Weinzimer SA, Steffen AT, Ahern JAH, Vincent M, Tamborlane WV (2004) A randomized prospective trial comparing the efficacy of continuous subcutaneous insulin infusion with multiple daily injections using insulin glargine. Diabetes Care 27:1554–1558PubMedCrossRefGoogle Scholar
  25. 25.
    Nabhan ZM, Kreher NC, Greene DM, Eugster EA, Kronenberger W, DiMeglio LA (2009) A randomized prospective study of insulin pump vs. insulin injection therapy in very young children with type 1 diabetes: 12-month glycemic, BMI, and neurocognitive outcomes. Pediatr Diabetes 10(3):202–208PubMedCrossRefGoogle Scholar
  26. 26.
    DiMeglio LA, Pottorff TM, Boyd SR, France L, Fineberg N, Eugster EA (2004) A randomized, controlled study of insulin pump therapy in diabetic preschoolers. J Pediatr 145(3):380–384PubMedCrossRefGoogle Scholar
  27. 27.
    Berghaeuser MA, Kapellen T, Heidtmann B, Haberland H, Klinkert C, Holl RW, German Working Group for Insulin Pump Treatment in Paediatric Patients (2008) Continuous subcutaneous insulin infusion in toddlers starting at diagnosis of type 1 diabetes mellitus. A multicenter analysis of 104 patients from 63 centres in Germany and Austria. Pediatr Diabetes 9(6):590–595PubMedCrossRefGoogle Scholar
  28. 28.
    Shehadeh N, Battelino T, Galatzer A, Naveh T, Hadash A, de Vries L, Phillip M (2004) Insulin pump therapy for 1–6 year old children with type 1 diabetes. Isr Med Assoc J 6:284–286PubMedGoogle Scholar
  29. 29.
    Jeha GS, Karaviti LP, Anderson B, Smith EO, Donaldson S, McGirk TS, Haymond MW (2005) Insulin pump therapy in preschool children with type 1 diabetes mellitus improves glycemic control and decreases glucose excursions and the risk of hypoglycemia. Diabetes Technol Ther 7(6):876–884PubMedCrossRefGoogle Scholar
  30. 30.
    Swift PGF, Skinner TC, De Beaufort CE, Cameron FJ, Aman J, Aanstoot HJ, Castaño L, Chiarelli F, Daneman D, Danne T, Dorchy H, Hoey H, Kaprio EA, Kaufman F, Kocova M, Mortensen HB, Njølstad PR, Phillip M, Robertson KJ, Schoenle EJ, Urakami T, Vanelli M, Ackermann RW, Skovlund SE, Hvidoere Study Group on Childhood Diabetes (2010) Target setting in intensive insulin management is associated with metabolic control: the Hvidoere Childhood Diabetes Study Group Centre Differences Study 2005. Pediatr Diabetes 11(4):271–278PubMedCrossRefGoogle Scholar
  31. 31.
    Luna R, Fluiters E, Rodriguez I, Garcia-Mayor RV (2004) Growth in type 1 diabetic children. Diabet Med 21(9):1054–1056PubMedCrossRefGoogle Scholar
  32. 32.
    Choudhury S, Stutchfield P (2000) Linear growth and weight gain in diabetic children a cross-sectional and longitudinal evaluation. J Pediatr Endocrinol Metab 13:537–544PubMedCrossRefGoogle Scholar
  33. 33.
    Cameron FJ, Skinner TC, de Beaufort CE, Hoey H, Swift PG, Aanstoot H, Aman J, Martul P, Chiarelli F, Daneman D, Danne T, Dorchy H, Kaprio EA, Kaufman F, Kocova M, Mortensen HB, Njølstad PR, Phillip M, Robertson KJ, Schoenle EJ, Urakami T, Vanelli M, Ackermann RW, Skovlund SE, Hvidoere Study Group on Childhood Diabetes (2008) Are family factors universally related to metabolic outcome in adolescents with type 1 diabetes? Diabet Med 25(4):463–468PubMedCrossRefGoogle Scholar
  34. 34.
    Urbach SL, LaFranchi S, Lambert L, Lapidus JA, Daneman D, Becker T (2005) Predictors of glucose control in children and adolescents with type 1 diabetes mellitus. Pediatr Diabetes 6:69–74PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.The Jesse Z and Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood DiabetesSchneider Children’s Medical Center of IsraelPetach TikvaIsrael
  2. 2.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael

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