VIENNA – Young people worldwide who have type 1 diabetes are not achieving their glycemic targets and, as a result, experience suboptimal outcomes.
About 70% of children and teens and 81% of young adults did not meet their hemoglobin A1c targets, in a large records review. As a result, many are experiencing significantly more complications from poorly controlled diabetes, Dr. Lori Laffel and her colleagues reported at the annual meeting of the European Association for the Study of Diabetes.
“These results highlight the need for further improvements in the management of glycemic control ... in young people with type 1 diabetes, particularly for patents aged 19-25 years,” wrote Dr. Laffel, chief of the pediatric, adolescent, and young adult section at the Joslin Diabetes Center, Boston.
The study comprised the European participants (2,943) in the TEENs study, a worldwide, observational study of 5,960 young patients with type 1 diabetes (aged 8-25 years) who were treated at 219 centers in 20 countries. The target HbA1c levels varied by age: 7.5% for patients 18 years and younger, and 7% for those 19 years and older. Younger patients were divided into two groups (8-12 and 13-18 years old), while the third group comprised those aged 19-25 years.
The overall mean HbA1c in was 8.5%, with 35% of the entire group meeting their goals. Control rates did not vary much among the younger patients (39% in those aged 8-12 years and 37% in those aged 12-18 years). A smaller percentage of the older patients stayed on target (23%).
Associated complications were significantly more common in uncontrolled patients: In the 6 months before data were collected, about 6% of both younger groups and 7% of the older group had experienced diabetic ketoacidosis. In contrast, the incidence among well-controlled patients in all three groups was about 3%.
The oldest uncontrolled patients also had the highest incidence of severe hypoglycemia resulting in loss of consciousness or seizure – 6% compared to 36% of well-controlled patients that age.
Among the youngest uncontrolled patients, the incidence was less than 3% in each group. Severe hypoglycemia incidence was similar in the middle group, at about 2% in the uncontrolled vs. 3% in the controlled patients.
The incidence of microalbuminuria soared among the oldest uncontrolled patients, reaching almost 9%, compared with just under 6% of controlled patients. For the youngest patients, the rates were similar (about 1% of each group). It was doubled in the middle group, at 5% in uncontrolled vs. 2.4% of controlled patients.
Neuropathy occurred in 10% of the oldest uncontrolled patients vs. 8% of well controlled. For the youngest, the rates doubled (3% vs. 1.5%, respectively). They more than doubled in the middle group (almost 6% vs. 2%).
The rates of retinopathy needing treatment were also elevated in the oldest uncontrolled patients, compared with the controlled patients (4% vs. 1.5%). However, in both younger groups, they were well under 1% regardless of control.
A multivariate analysis determined that diabetic ketoacidosis and diabetic neuropathy were significantly associated with uncontrolled HbA1c (odds ratio, 0.53 and 0.47, respectively).
Dr Laffel has received research support from Sanofi-Aventis, which funded the study, as well as other pharmaceutical companies. Two coauthors were Sanofi employees.
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