Original articlesPredictors of glycemic control and short-term adverse outcomes in youth with type 1 diabetes*,**
Section snippets
Participants
Study participants were youth, aged 7 to 16 years, with type 1 diabetes, who received care in the Pediatric and Adolescent Unit of the Joslin Diabetes Center and were to be part of a subsequent prospective, longitudinal study to evaluate the effectiveness of a psycho-educational intervention aimed at improving glycemic control and reducing short-term adverse outcomes in patients with type 1 diabetes. This report provides baseline data on the study cohort.
Patients’ medical records were reviewed
Description of Study Population
Of the questionnaire respondents, 85% were patients’ mothers, 14% were fathers, and 1% were other primary caretakers (eg, a grandparent). No patients were receiving insulin pump therapy.
Baseline characteristics of the 300 study participants were, in general, similar between the 131 males and the 169 females but differed slightly with respect to pubertal status and total daily dose of insulin. Although 16% of the males were postpubertal (Tanner stage V), 29% of the females were postpubertal.
Discussion
Despite multidisciplinary specialty care, overall glycemic control in our population of 300 children with type 1 diabetes was suboptimal, with mean HbA1c values of 8.7% ± 1.2% at baseline and 8.9% ± 1.5% at 1-year follow-up. Only 33% (98/300) of our patients had a baseline HbA1c level below 8.1%, the threshold above which the risk of microalbuminuria is known to rise steeply7 and above which the American Diabetes Association recommends “additional action” to improve glycemic control.8 Although
Acknowledgements
We acknowledge the contributions of the clinical team in the Pediatric and Adolescent Unit of the Joslin Clinic: Joan Mansfield, MD, Alyne Ricker, MD, Cindy Pasquarello, RN, BSN, CDE, Kristen Rice, RN, BSN, CDE, and Louise Crescenzi, AS.
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2020, Social Science and MedicineCitation Excerpt :T1D management steadily deteriorates across adolescence (e.g., poorer adherence and glycemic control), reaching a nadir in the late adolescence–early emerging adulthood period (Clements et al., 2016; Miller et al., 2015). This decline is concerning because poor glycemic control is associated with short- (e.g., diabetic ketoacidosis, hypoglycemia; Levine et al., 2001) and long-term health complications (e.g., nephropathy; White, 2015). Because patterns of diabetes management in adolescence may set the stage for management across emerging adulthood (Helgeson et al., 2017), it is imperative to understand factors that might contribute to lower adherence and higher HbA1c (i.e., poorer glycemic control) at this time of development.
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Supported by the National Institute of Diabetes, Digestive, and Kidney Diseases, Grant No. DK46887; RNSA National Institute of Health Institutional Training Grant No. T32 DK07260; the Agency for Healthcare Research and Quality, US Department of Health and Human Services, Grant No. T32 HS00063 to the Harvard Pediatric Health Services Research Fellowship Program; and the Charles H. Hood Foundation.
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Reprint requests: Lori M. B. Laffel, MD, MPH, Pediatric and Adolescent Unit, Section of Genetics and Epidemiology, Joslin Diabetes Center, One Joslin Pl, Boston, MA 02215.