Glycated hemoglobin A1c as a risk factor for severe hypoglycemia in pediatric type 1 diabetes

Objective: As diabetes technology use in youth increases worldwide, inequalities in access may exacerbate disparities in hemoglobin A1c (HbA1c). We hypothesized an increasing gap in diabetes technology use by socioeconomic status (SES) would be associated with increased HbA1c disparities. Research Design and Methods: Participants aged <18 years with diabetes duration ≥1 year in the Type 1 Diabetes Exchange (T1DX, US, n=16,457) and Diabetes Prospective Follow-up (DPV, Germany, n=39,836) registries were categorized into lowest (Q1) to highest (Q5) SES quintiles. Multiple regression analyses compared the relationship of SES quintiles with diabetes technology use and HbA1c from 2010-2012 and 2016-2018. Results: HbA1c was higher in participants with lower SES (in 2010-2012 & 2016-2018, respectively: 8.0% & 7.8% in Q1 and 7.6% & 7.5% in Q5 for DPV; and 9.0% & 9.3% in Q1 and 7.8% & 8.0% in Q5 for T1DX). For DPV, the association between SES and HbA1c did not change between the two time periods, whereas for T1DX, disparities in HbA1c by SES increased significantly (p<0.001). After adjusting for technology use, results for DPV did not change whereas the increase in T1DX was no longer significant. Conclusions: Although causal conclusions cannot be drawn, diabetes technology use is lowest and HbA1c is highest in those of the lowest SES quintile in the T1DX and this difference for HbA1c broadened in the last decade. Associations of SES with technology use and HbA1c were weaker in the DPV registry.

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Review for "Episodes of severe hypoglycemia is associated with a progressive increase in hemoglobin A1c in children and adolescents with type 1 diabetes"

10.1111/pedi.13020/v2/review2 ◽

2020 ◽

Keyword(s):

Type 1 Diabetes ◽

Children And Adolescents ◽

Hemoglobin A1c ◽

Severe Hypoglycemia ◽

Progressive Increase

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Type 1 Diabetes in the Young: Organization of two National Centers in Israel and Slovenia / Sladkorna Bolezen Tipa 1 Pri Otrocih in Mladostnikih: Organizacija Dela V Dveh Nacionalnih Centrih V Izraelu in Sloveniji

Slovenian Journal of Public Health ◽

10.1515/sjph-2015-0021 ◽

2015 ◽

Vol 54 (2) ◽

pp. 139-145 ◽

Cited By ~ 1

Author(s):

Nataša Bratina ◽

Shlomit Shalitin ◽

Moshe Phillip ◽

Tadej Battelino

Keyword(s):

Type 1 Diabetes ◽

Glycated Hemoglobin ◽

Severe Hypoglycemia ◽

Modern Technology ◽

Steady Increase ◽

Chronic Complications ◽

The Mean ◽

Chronic Autoimmune Disease

Abstract Type 1 diabetes is a chronic autoimmune disease that affects mainly young people. In the last 50 years, a steady increase of the T1D incidence in the young is reported worldwide, with an average 4 % increase annually. In addition, the mean age at the diagnosis is decreasing. Studies show that good metabolic control is important not only for delaying the chronic complications of diabetes but also for improving the quality of life of patients and their families. Continuous education, together with modern technology, is crucial in achieving these goals. Longitudinal data on glycated hemoglobin (HbA1c), along with the data on severe hypoglycemia and severe diabetic ketoacidosis, can describe the quality of care in a defined population. Two national reference diabetes centres taking care of children, adolescents and young adults with diabetes in Israel and Slovenia are described.

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Racial Disparities on Glycemic Control and Lipid Profiles in Children with Type 1 Diabetes

Clinical medicine Endocrinology and diabetes ◽

10.4137/cmed.s1065 ◽

2009 ◽

Vol 2 ◽

pp. CMED.S1065

Author(s):

Ambika Ashraf ◽

Yufeng Li ◽

Frank Franklin ◽

Kenneth McCormick ◽

Elaine Moreland

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Hemoglobin A1c ◽

Outcome Measure ◽

Glycated Hemoglobin ◽

Temporal Trends ◽

Black Children ◽

Lipid Profiles ◽

The Mean

Objective We assessed the racial (Black–White) differences in glycemic control, prevalence of abnormal lipid profiles and factors influencing temporal trends in children with type 1 diabetes (T1DM). Methods This retrospective study was done in children with T1DM. The outcome measure was based on glycemic control and all lipid determinations which were stratified according to the published guidelines. Results The study included 181 children; 76.2% Whites and 23.8% Blacks. The mean glycated hemoglobin (A1C) was higher in Blacks than in Whites (p < 0.0001). Blacks had elevated total cholesterol (TC) (p = 0.0013), lower TC/HDL ratio (p < 0.0001) and higher concentration of HDL (<0.0001) when compared to Whites. The longitudinal analyses over a 5 year period showed changes in A1C significantly associated with changes in the lipid profiles. The lipid profiles in Blacks were more altered by the trend in A1C with changes in the TC (p = 0.0079), non-HDL (p < 0.0001) and HDL (p < 0.0001). Conclusions Black children with T1DM have poorer glycemic control. However they retained excellent levels of HDL when compared to Whites.

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