Optimal Glycemic Control Lacking in Youth and Young Adults With Diabetes

The adjusted mean glycated hemoglobin (HbA_1c) for youth and young adults (YYA) with type 1 diabetes (T1D) has increased from 2002-2007 to 2014-2019, and the adjusted mean HbA_1c in YYA with type 2 diabetes (T2D)  has been relatively unchanged in the same period, researchers reported in Diabetes Care.

The investigators sought to assess temporal trends in glycemic control according to age and diabetes duration in patients with youth-onset T1D or T2D based on earlier data from the SEARCH for Diabetes in Youth study

The analysis included 6369 participants—5482 with T1D and 887 with T2D. Data used in the current study were categorized into 3 groups: duration of diabetes (1-4 years, 5-9 years, and ≥10 years), time periods (2002-2007, 2008-2013, and 2014-2019), and age  (1-9, 10-14, 15-19, 20-24, and ≥25 years). Multivariable regression models stratified by duration group were used to determine differences in HbA_1c over time after adjustment for clinical site, age, sex, race/ethnicity, household income, health insurance status, insulin regimen, and disease duration.

The estimated average adjusted HbA_1c for the 2014-2019 cohort (n = 1742; 50.8% female) with T1D was 8.8±0.04% (72 mmol/mol). A statistically significant difference was observed in HbA_1c among the groups, as the average adjusted HbA_1c for the 2014-2019 cohort with T1D was 0.3% higher than the mean HbA_1c for the 2002-2007 cohort (8.5±0.03% [70 mmol/mol]; n = 3398; 49.4% female).

Multivariate analysis of the patients with T1D in the 2014-2019 cohort found that glycemic control was significantly associated with race/ethnicity, age, body mass index (BMI), insulin regimen, blood glucose monitoring frequency, and household income.

Among patients with T2D, the 2014-2019 cohort (n = 519; 65.1% female) had an adjusted HbA_1c of 8.6±0.12% (70 mmol/mol), which was similar to that of the 2002-2007 cohort (8.7% [72 mmol/mol; n = 379; 62.0% female] but was higher vs the 2008-2013 cohort (8.3% [67 mmol/mol]; n = 327; 62.7% female).

Among patients with T2D in the 2014-2019 cohort, multivariate analysis showed that HbA_1c was associated with BMI and medication regimen, with those receiving metformin having a lower HbA_1c vs those on insulin.

Youth and young adults with T2D and a diabetes duration of ≥10 years had a temporal trend of worse glycemic control (2008-2013: 8.4% [68 mmol/mol] vs 2014-2019: 10.1% [87 mmol/mol]).

While researchers noted SEARCH was the largest multi-ethnic, population-based study of diabetes of these ages group in the US, there were limitations. Data were only available for participants who attended study visits, which could limit the generalizability of the findings. Also, the investigators were unable to meaningfully estimate the impact of increased continuous glucose monitoring (CGM) use on glycemic control in the absence of blood glucose monitoring frequency. They were also unable to account for unmeasured residual confounding.

“Many YYA with diabetes in the US are not meeting desired glycemic targets despite increased availability of advanced diabetes technologies, newer therapies, and more aggressive glycemic targets over time,” the study authors concluded. “Recognizing that lower HbA_1C levels in childhood and young adulthood are associated with lower risk and rate of microvascular and macrovascular complications, this study further underscores the urgent need for implementation of effective treatment strategies to improve metabolic status in YYA with diabetes.”

Reference

Malik FS, Sauder KA, Isom S, et al. Trends in glycemic control among youth and young adults with diabetes: The SEARCH for diabetes in youth study. Diabetes Care. 2022;45(2):285-294. doi:10.2337/dc21-0507