Diabetic ketoacidosis at diagnosis of type 1 diabetes and glycemic control over time: The SEARCH for diabetes in youth study

OBJECTIVES: To describe temporal trends and correlates of glycemic control in youth and young adults (YYA) with youth-onset diabetes. RESEARCH DESIGN AND METHODS: The study included 6,492 participants with type 1 or type 2 diabetes from the SEARCH for Diabetes in Youth study. Participant visit data were categorized into time periods 2002-2007, 2008-2013 and 2014-2019, diabetes durations of 1-4, 5-9, and 10+ years, and age groups 1-9, 10-14, 15-19, 20-24, 25+ years. Participants contributed one randomly selected data point to each duration and age group per time period. Multivariable regression models were used to test differences in hemoglobin A1c (HbA1c) over time by diabetes type. Models were adjusted for site, age, sex, race/ethnicity, household income, health insurance status, insulin regimen and diabetes duration, overall and stratified for each duration and age group. RESULTS: Adjusted mean HbA1c for the 2014-2019 cohort of YYA with type 1 diabetes was 8.8%±0.04%. YYA with type 1 diabetes in the 10-14, 15-19, and 20-24 age groups from the 2014-2019 cohort had worse glycemic control than the 2002-2007 cohort. Race/ethnicity, household income and treatment regimen predicted differences in glycemic control in 2014-2019 type 1 diabetes participants. Adjusted mean HbA1c was 8.6%±0.12% for 2014-2019 YYA with type 2 diabetes. Participants age 25+ with type 2 diabetes had worse glycemic control relative to the 2008-2013 cohort. Only treatment regimen was associated with differences in glycemic control in type 2 diabetes participants. CONCLUSIONS: Despite advances in diabetes technologies, medications, and dissemination of more aggressive glycemic targets, many current YYA are less likely to achieve desired glycemic control relative to earlier cohorts.

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189-LB: Household Food Insecurity and Associations with Glycemic Control and Acute Diabetes-Related Complications in Youth and Young Adults with Type 1 Diabetes: The SEARCH for Diabetes in Youth Study

Diabetes ◽

10.2337/db20-189-lb ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 189-LB

Author(s):

FAISAL MALIK ◽

ANGELA D. LIESE ◽

ALICE M. ELLYSON ◽

LAUREN A. REID ◽

KATHERINE A. SAUDER ◽

...

Keyword(s):

Type 1 Diabetes ◽

Young Adults ◽

Glycemic Control ◽

Household Food Insecurity ◽

Household Food ◽

Youth And Young Adults ◽

Acute Diabetes ◽

Youth Study ◽

Diabetes In Youth

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Trends in Glycemic Control Among Youth and Young Adults With Diabetes: The SEARCH for Diabetes in Youth Study

Diabetes Care ◽

10.2337/dc21-0507 ◽

2022 ◽

Author(s):

Faisal S. Malik ◽

Katherine A. Sauder ◽

Scott Isom ◽

Beth A. Reboussin ◽

Dana Dabelea ◽

...

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Age Groups ◽

Youth And Young Adults ◽

Race Ethnicity ◽

Youth Study ◽

Diabetes In Youth

OBJECTIVES To describe temporal trends and correlates of glycemic control in youth and young adults (YYA) with youth-onset diabetes. RESEARCH DESIGN AND METHODS The study included 6,369 participants with type 1 or type 2 diabetes from the SEARCH for Diabetes in Youth study. Participant visit data were categorized into time periods of 2002–2007, 2008–2013, and 2014–2019, diabetes durations of 1–4, 5–9, and ≥10 years, and age groups of 1–9, 10–14, 15–19, 20–24, and ≥25 years. Participants contributed one randomly selected data point to each duration and age group per time period. Multivariable regression models were used to test differences in hemoglobin A1c (HbA1c) over time by diabetes type. Models were adjusted for site, age, sex, race/ethnicity, household income, health insurance status, insulin regimen, and diabetes duration, overall and stratified for each diabetes duration and age group. RESULTS Adjusted mean HbA1c for the 2014–2019 cohort of YYA with type 1 diabetes was 8.8 ± 0.04%. YYA with type 1 diabetes in the 10–14-, 15–19-, and 20–24-year-old age groups from the 2014–2019 cohort had worse glycemic control than the 2002–2007 cohort. Race/ethnicity, household income, and treatment regimen predicted differences in glycemic control in participants with type 1 diabetes from the 2014–2019 cohort. Adjusted mean HbA1c was 8.6 ± 0.12% for 2014–2019 YYA with type 2 diabetes. Participants aged ≥25 years with type 2 diabetes had worse glycemic control relative to the 2008–2013 cohort. Only treatment regimen was associated with differences in glycemic control in participants with type 2 diabetes. CONCLUSIONS Despite advances in diabetes technologies, medications, and dissemination of more aggressive glycemic targets, many current YYA are less likely to achieve desired glycemic control relative to earlier cohorts.

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Trends in Glycemic among Youth with Diabetes: The SEARCH for Diabetes in Youth Study

10.2337/figshare.17052590 ◽

2022 ◽

Author(s):

Faisal S. Malik ◽

Katherine A. Sauder ◽

Scott Isom ◽

Beth A. Reboussin ◽

Dana Dabelea ◽

...

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Household Income ◽

Age Groups ◽

Race Ethnicity ◽

Youth Study ◽

Diabetes In Youth

OBJECTIVES: To describe temporal trends and correlates of glycemic control in youth and young adults (YYA) with youth-onset diabetes. RESEARCH DESIGN AND METHODS: The study included 6,492 participants with type 1 or type 2 diabetes from the SEARCH for Diabetes in Youth study. Participant visit data were categorized into time periods 2002-2007, 2008-2013 and 2014-2019, diabetes durations of 1-4, 5-9, and 10+ years, and age groups 1-9, 10-14, 15-19, 20-24, 25+ years. Participants contributed one randomly selected data point to each duration and age group per time period. Multivariable regression models were used to test differences in hemoglobin A1c (HbA1c) over time by diabetes type. Models were adjusted for site, age, sex, race/ethnicity, household income, health insurance status, insulin regimen and diabetes duration, overall and stratified for each duration and age group. RESULTS: Adjusted mean HbA1c for the 2014-2019 cohort of YYA with type 1 diabetes was 8.8%±0.04%. YYA with type 1 diabetes in the 10-14, 15-19, and 20-24 age groups from the 2014-2019 cohort had worse glycemic control than the 2002-2007 cohort. Race/ethnicity, household income and treatment regimen predicted differences in glycemic control in 2014-2019 type 1 diabetes participants. Adjusted mean HbA1c was 8.6%±0.12% for 2014-2019 YYA with type 2 diabetes. Participants age 25+ with type 2 diabetes had worse glycemic control relative to the 2008-2013 cohort. Only treatment regimen was associated with differences in glycemic control in type 2 diabetes participants. CONCLUSIONS: Despite advances in diabetes technologies, medications, and dissemination of more aggressive glycemic targets, many current YYA are less likely to achieve desired glycemic control relative to earlier cohorts.

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Abstract P059: Association Of Uric Acid With Change In Arterial Stiffness And Blood Pressure Over Time In Type 1 Diabetes Mellitus: The SEARCH For Diabetes In Youth Study

Hypertension ◽

10.1161/hyp.76.suppl_1.p059 ◽

2020 ◽

Vol 76 (Suppl_1) ◽

Author(s):

Andrew M South ◽

Joseph Rigdon ◽

Jeanette M Stafford ◽

Dana Dabelea ◽

Jean Lawrence ◽

...

Keyword(s):

Type 1 Diabetes ◽

Uric Acid ◽

Arterial Stiffness ◽

Cvd Risk ◽

History Of ◽

Youth Study ◽

Multivariable Regression Models ◽

Diabetes In Youth ◽

Over Time

Background: Type 1 diabetes (T1D) increases CVD risk, and early detection of CV changes could mitigate CVD risk. Increased arterial stiffness is an early marker of adverse CV health and precedes hypertension. Uric acid has been associated with arterial stiffness, hypertension, and CVD in select conditions such as obesity, but its relationship to T1D is undefined. We hypothesized that uric acid predicts increased arterial stiffness and BP over time in youth with T1D, especially those with overweight/obesity. Methods: Prospective cohort of 451 participants with T1D from the SEARCH for Diabetes in Youth Study. We measured uric acid, BP, and arterial stiffness assessed by pulse wave velocity (PWV) in the arm (PWV-R), trunk (PWV-T), and lower extremity (PWV-LE). BP and PWV were repeated a mean of 4.5 years later (±1.1). We defined high BP as ≥90 th %ile for age/sex/height (<13 years) and ≥120/80 mmHg (≥13 years). We applied multivariable regression models to estimate the association of uric acid with annualized changes in each outcome. Directed acyclic graph-informed models were adjusted for age, sex, race/ethnicity, health insurance, family history of CVD, A1c, antihypertensive use, T1D duration, dyslipidemia, and study site. We assessed for effect modification by overweight/obesity. Results: Mean age was 18.1 years (±4.5), 50.8% (229/451) were female, 66.1% (298/451) were White, and 42.4% (191/451) had overweight/obesity. A 1 mg/dl increase in uric acid was associated with increased PWV-R (adjusted β : 0.02 m/s/year, 95% CI -0.01 to 0.06), decreased SBP (-0.45 mmHg/year, -0.73 to -0.18), and sustained high BP (referenced to normal BP, adjusted OR 1.28, 0.91 to 1.79), but not PWV-T or PWV-LE. Compared to normal BMI, those with overweight/obesity demonstrated somewhat stronger associations between uric acid and PWV-R (0.05 m/s/year, 0.0 to 0.1 vs. 0.0 m/s/year, -0.05 to 0.05, interaction p =0.17) and sustained high BP (1.58, 0.99 to 2.51 vs. 0.79, 0.44 to 1.4, interaction p =0.06). Discussion: Among participants with T1D, uric acid was modestly associated with changes in PWV-R and BP over time, particularly in those with overweight/obesity. Further investigations are warranted to determine uric acid’s role in hypertension and arterial stiffness in T1D.

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