Original articles
Predictors of glycemic control and short-term adverse outcomes in youth with type 1 diabetes*,**

Portions of this paper were presented at the American Diabetes Association Annual Scientific Meetings, June 1998, and the Year 2000 Pediatric Academic Societies and American Academy of Pediatrics Joint Meeting, May 2000.
https://doi.org/10.1067/mpd.2001.116283Get rights and content

Abstract

Objectives: To examine predictors of glycemic control and to assess how glycemic control affects the incidence of short-term adverse outcomes in a pediatric population with type 1 diabetes. Study design: Three hundred youth, aged 7 to 16 years, with type 1 diabetes who were receiving diabetes specialty care were followed up prospectively for 1 year. Treatment plans and frequency of adverse outcomes were ascertained by questionnaires and medical record review. Incidence rates of adverse outcomes were compared among 3 strata of the population, representing tertiles of baseline glycosylated hemoglobin (HbA1c). Results: Blood glucose monitoring frequency was the sole modifiable predictor of HbA1c (P <.0001). Overall incidence rate of hospitalization was 13 per 100 person-years, more than 3 times the rate in the general pediatric population and significantly higher in the upper HbA1c tertile compared with the other strata (P =.001). Rate of emergency department use was 29 per 100 person-years and did not differ significantly among tertiles. Incidence of severe hypoglycemia was 62 per 100 person-years and notably high even in those with poorest glycemic control. Conclusion: Despite improvements in diabetes care, the incidence of short-term adverse events in children with type 1 diabetes remains high, particularly in those with poorest glycemic control. (J Pediatr 2001;139:197-203)

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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    *

    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.

    **

    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.

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