HbA1c at type 1 diabetes onset, not DKA status, predicts later glycemic response among children
December 11, 2019
HbA1c value 3 years after a type 1 diabetes diagnosis is more closely associated with HbA1c at disease onset and not with diabetic ketoacidosis, or DKA, at presentation, according to findings from a registry-based study published in Pediatric Diabetes.
“Lower residual beta-cell function and poorer glycemic control during the following 1 to 2 years have been shown in children with DKA at presentation,” Barbara Piccini, MD, PhD, of the diabetology unit of Meyer Children’s Hospital in Florence, Italy, and colleague wrote in the study background. “What remains to be further examined is whether it is chronic hyperglycemia or DKA at diagnosis that is the most important variable determining the following metabolic control.”
In a cross-sectional, observational study, Piccini and colleagues analyzed information from 1,420 children with type 1 diabetes using data from the international, prospective SWEET registry (median age at diabetes onset, 9 years; 54% boys). Researchers categorized children according to type 1 diabetes onset: DKA (DKA with coma, DKA without coma and no DKA) and HbA1c at onset (< 10%, 10% to < 12%, or 12%). Researchers used linear regression analyses to estimate the associations between 3-year HbA1c and both HbA1c and presentation at diabetes onset.
Within the cohort, 16% experienced DKA with coma, 27% experienced DKA without coma and 57% had no DKA at presentation. There were no between-sex differences in clinical presentation at onset.
HbA1c value 3 years after a type 1 diabetes diagnosis is more closely associated with HbA1c at disease onset and not with diabetic ketoacidosis, or DKA, at presentation.
HbA1c at 3 years was lower among children with an HbA1c of 10% or lower at presentation when compared with children with a high HbA1c at diabetes onset, both in the DKA without coma group (mean HbA1c, 7.1% vs. 7.6%; P = .03) and in the no DKA group (mean HbA1c, 7.4% vs 7.8%; P = .01). There were no differences between children with low and medium HbA1c at onset groups
In the DKA with coma group, researchers found that HbA1c at year 3 did not differ among HbA1c at onset groups. HbA1c at onset as an explanatory variable was more closely associated with HbA1c at year 3 vs. presentation at onset groups (P = .02).
“While children who experienced DKA at onset can achieve a good metabolic control, patients with high HbA1c at onset continue to have poor metabolic control as a group,” the researchers wrote. “Coma itself is also associated with subsequent poor metabolic control. These results emphasize the importance of identifying from the very beginning of type 1 diabetes a subset of children (eg, those with HbA1c at onset 12% and those with DKA and coma, especially if younger) at major risk of future poor metabolic control, in order to implement intensive education and recent technological advances. Early detection of type 1 diabetes, preventing a high HbA1c at onset as well as DKA at onset with coma, is crucial to improving year-3 HbA1c.”
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