Article ; Online: National Trends in Hyperglycemia and Diabetic Ketoacidosis in Children, Adolescents, and Young Adults With Type 1 Diabetes: A Challenge Due to Age or Stage of Development, or Is New Thinking About Service Provision Needed?
2023 Volume 46, Issue 7, Page(s) 1404–1408
Abstract: Objective: Adolescence is associated with high-risk hyperglycemia. This study examines the phenomenon in a life course context.: Research design and methods: A total of 93,125 people with type 1 diabetes aged 5 to 30 years were identified from the ... ...
| Abstract | Objective: Adolescence is associated with high-risk hyperglycemia. This study examines the phenomenon in a life course context. Research design and methods: A total of 93,125 people with type 1 diabetes aged 5 to 30 years were identified from the National Diabetes Audit and/or the National Paediatric Diabetes Audit for England and Wales for 2017/2018-2019/2020. For each audit year, the latest HbA1c and hospital admissions for diabetic ketoacidosis (DKA) were identified. Data were analyzed in sequential cohorts by year of age. Results: In childhood, unreported HbA1c measurement is uncommon; however, for 19-year-olds, it increases to 22.3% for men and 17.3% for women, and then reduces to 17.9% and 13.1%, respectively, for 30-year-olds. Median HbA1c for 9-year-olds is 7.6% (60 mmol/mol) (interquartile range 7.1-8.4%, 54-68 mmol/mol) in boys and 7.7% (61 mmol/mol) (8.0-8.4%, 64-68 mmol/mol) in girls, increasing to 8.7% (72 mmol/mol) (7.5-10.3%, 59-89 mmol/mol) and 8.9% (74 mmol/mol) (7.7-10.6%, 61-92 mmol/mol), respectively, for 19-year-olds before falling to 8.4% (68 mmol/mol) (7.4-9.7%, 57-83 mmol/mol) and 8.2% (66 mmol/mol) (7.3-9.7%, 56-82 mmol/mol), respectively, for 30-year-olds. Annual hospitalization for DKA rose steadily in age from 6 years (2.0% for boys, 1.4% for girls) and peaked at 19 years for men (7.9%) and 18 years for women (12.7%), reducing to 4.3% for men and 5.4% for women at age 30 years. For all ages over 9 years, the prevalence of DKA was higher in female individuals. Conclusions: 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. |
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| MeSH term(s) | Male ; Child ; Humans ; Female ; Adolescent ; Young Adult ; Adult ; Diabetes Mellitus, Type 1/epidemiology ; Diabetes Mellitus, Type 1/complications ; Diabetic Ketoacidosis/epidemiology ; Diabetic Ketoacidosis/complications ; Glycated Hemoglobin ; Hyperglycemia/epidemiology ; Hyperglycemia/complications ; England/epidemiology |
| Chemical Substances | Glycated Hemoglobin |
| Language | English |
| Publishing date | 2023-05-20 |
| Publishing country | United States |
| Document type | Journal Article ; Research Support, Non-U.S. Gov't |
| ZDB-ID | 441231-x |
| ISSN | 1935-5548 ; 0149-5992 |
| ISSN (online) | 1935-5548 |
| ISSN | 0149-5992 |
| DOI | 10.2337/dc23-0180 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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