The effect of glycated hemoglobin variability on the development of microvascular complications in patients with type 1 diabetes

Introduction. The results of a 25-year observational program to assess the effect of glycated hemoglobin variability on the development of microvascular complications in patients with type 1 diabetes mellitus are presented.Objective: This study aimed to evaluate the effect of glycated hemoglobin (HbA1c) variability on the development of microvascular complications in patients with type 1 diabetes mellitus (DM1) and disease duration of 25 years.Materials and methods: A retrospective analysis of the database of patients with DM1 was performed from the moment of the disease manifestation until the time of the last visit. Determination of HbA1c level is carried out using parameters certified in accordance with the National Standard for Glycohemoglobin Standardization (NGSP) or the International Federation of Clinical Chemists (IFCC). HbA1c variability was determinated by average current HbA1c, average of longitudinal HbA1c (from the manifestation to the last visit – 2019), median and maximum of difference in changes of HbA1c (median and max∆HbA1c). Statistical analysis was performed by IBM SPSS Statistics ver.22. A statistically significant difference is the value p < 0.05.Results. A total of 88 patients were enrolled in this study, they were divided in 3 groups depending on the registered microvascular complications (MVC): without MVC (n = 38), isolated MVC (retinopathy or nephropathy) (n = 25) and multiple MVC (retinopathy and nephropathy) (n = 25). Clinical characteristics [median (25; 75 percentile)]: age of manifestation of DM1 is 9 years (5; 12), age of patients at the time of the last visit is 33 years (29; 35), duration of DM1 is 24 years (20; 27), body mass index 24 kg/m2 (21; 25). Medication: basal-bolus insulin therapy (n = 82) or pump insulin therapy (n = 6). The average level of longitudinal HbA1c for the three groups was: 8% (7.6; 8.9), 8.5% (7.9; 8.9), 8.6% (7.8; 10), p = 0.2. Average of current (at the time of the last visit) HbA1c – 8.2% (7.2; 9.0), 8.1% (7.5; 9.0), 8.4% (7.3; 9.7), p = 0.4. Statistically significant differences were determined in the group without complications and in the group with multiple complications between the levels of maxΔ HbA1c 2.3% (1.8; 2.8) vs 4.7% (3.2; 5.6), p < 0.0001 and median Δ HbA1c 0.7% (0.6; 0.9) vs 1.4% (1; 1.7), р < 0.0001. There were no statistically significant relationships between the maximum and medianΔ HbA1c in the groups without complications and in the group with isolated complications.Conclusions: Longitudinal HbA1c and current HbA1c are not associated with the development of microvascular complications. The potential role in the development of microvascular complications was determined for the maximum and median Δ HbA1c.

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Glycated hemoglobin variability and microvascular complications in patients with type 1 diabetes mellitus

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2020-0337 ◽

2020 ◽

Vol 33 (12) ◽

pp. 1533-1537

Author(s):

Eren Er ◽

Aysun Ata ◽

Ferda Evin ◽

Yasemin Atik Altınok ◽

Günay Demir ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Glycated Hemoglobin ◽

Microvascular Complications ◽

Control Group ◽

Limit Value ◽

Hemoglobin Variability ◽

Age Of Diagnosis

AbstractObjectivesGlycated hemoglobin (HbA1c) has proven to be indicative in the development of microvascular complications. In this study, the contribution of HbA1c variability to microvascular complications was evaluated.MethodsTwenty-one cases with type 1 diabetes mellitus (T1DM) who developed microvascular complications and 39 cases without complications, that were similar in terms of gender, age of diagnosis, insulin treatment, insulin doses (U/kg), and mean HbA1c levels were included.ResultsMean age of T1DM diagnosis was 5.87 ± 3.93 years in the complication group and 4.63 ± 3.33 years in the control group. Nephropathy was detected in 17 cases, neuropathy in 8 cases, and retinopathy in 1 case. Nephropathy occurred at a mean age of 11.52 ± 4.12 years and neuropathy at 14.13 ± 5.68 years. The mean HbA1c during follow-up was similar in the group with complications and the control group (8.60 ± 0.63 vs. 8.84 ± 1.32). Adjusted HbA1c-standard deviation (SD) and HbA1c-variation coefficient (CV) values were 1.30 ± 0.65 and 14.36 ± 6.23 in the group with complications (p=0.014), and 0.91 ± 0.37 and 10.59 ± 4.01 in the control group (p=0.013). In the Receiver Operating Characteristic (ROC)-analysis for microvascular complications, the limit value HbA1c-CV was 11.99 (sensitivity: 61.9%, specificity: 71.9%). This value for HbA1c-SD was 0.9699 (sensitivity: 71.43%, specificity: 66.67%)ConclusionsThis study has shown that long-term fluctuations in HbA1c are associated with the development of microvascular complications in type 1 diabetes.

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Diagnosis and management of pediatric type 1 diabetes mellitus

Journal of Korean Medical Association ◽

10.5124/jkma.2021.64.6.425 ◽

2021 ◽

Vol 64 (6) ◽

pp. 425-431

Author(s):

Jieun Lee

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Blood Glucose ◽

Type 1 Diabetes Mellitus ◽

Glycated Hemoglobin ◽

Microvascular Complications ◽

Accurate Diagnosis ◽

Glucose Levels ◽

Blood Glucose Levels

Background: In contrast to type 2 diabetes, type 1 diabetes mellitus (T1DM) requires insulin treatment to control blood glucose. As the incidence and prevalence of T1DM have steadily increased; therefore, T1DM is increasingly being diagnosed not only in children and adolescents, but also in adults. Therefore, the importance of accurate diagnosis and optimal management of T1DM is being recognized in clinical practice.Current Concepts: T1DM is caused by insulin deficiency, following the destruction of insulin-producing pancreatic <i>β</i>-cells. Diagnosis of diabetes is based on the following criteria: fasting blood glucose levels ≥126 mg/dL, random blood glucose levels ≥200 mg/dL accompanied by symptoms of hyperglycemia, an abnormal 2-hour oral glucose tolerance test, or glycated hemoglobin ≥6.5%. Accurate diagnosis of T1DM based on patients’ clinical characteristics, serum C-peptide levels, and detection of autoantibodies against <i>β</i>-cell autoantigens is important for optimum care and to avoid complications. A target glycated hemoglobin level is recommended in children, adolescents, and young adults with access to comprehensive care. The availability of insulin analogues and mechanical technologies (insulin pumps and continuous glucose monitors) has improved the management of T1DM, and these are useful for the prevention of microvascular complications. Screening for microvascular complications should commence at puberty or 5 years after diagnosis of T1DM.Discussion and Conclusion: Effective cooperation and coordination between patient, parents, and healthcare providers are necessary to achieve a successful transition from pediatric to adult care in patients with T1DM. Diabetic management for T1DM should be individualized based on patients’ lifestyle, as well as psychosocial, and medical circumstances.

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Serum TRAIL levels increase shortly after insulin therapy and metabolic stabilization in children with type 1 diabetes mellitus

Acta Diabetologica ◽

10.1007/s00592-015-0731-2 ◽

2015 ◽

Vol 52 (5) ◽

pp. 1003-1006 ◽

Cited By ~ 3

Author(s):

Gianluca Tornese ◽

Veronica Tisato ◽

Lorenzo Monasta ◽

Liza Vecchi Brumatti ◽

Giorgio Zauli ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Insulin Therapy ◽

Type 1 Diabetes Mellitus

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Retinal vascular fractals predict long-term microvascular complications in type 1 diabetes mellitus: the Danish Cohort of Pediatric Diabetes 1987 (DCPD1987)

Diabetologia ◽

10.1007/s00125-014-3317-6 ◽

2014 ◽

Vol 57 (10) ◽

pp. 2215-2221 ◽

Cited By ~ 31

Author(s):

Rebecca Broe ◽

Malin L. Rasmussen ◽

Ulrik Frydkjaer-Olsen ◽

Birthe S. Olsen ◽

Henrik B. Mortensen ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Microvascular Complications ◽

Pediatric Diabetes ◽

Danish Cohort

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Intensive Insulin Therapy in Type 1 Diabetes Mellitus

Insulin Therapy ◽

10.1201/9780203910986.ch7 ◽

2002 ◽

Cited By ~ 1

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Insulin Therapy ◽

Type 1 Diabetes Mellitus ◽

Intensive Insulin Therapy

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Intensive Insulin Therapy in Type 1 Diabetes Mellitus

Insulin Therapy ◽

10.1201/b14038-10 ◽

2002 ◽

pp. 95-120

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Insulin Therapy ◽

Type 1 Diabetes Mellitus ◽

Intensive Insulin Therapy

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General Principles for Rehabilitation of Patients With Type 1 Diabetes and Diabetic Nephropathy

Bulletin of Science and Practice ◽

10.33619/2414-2948/73/13 ◽

2021 ◽

Vol 7 (12) ◽

pp. 97-103

Author(s):

O. Terekhova ◽

Furtikova

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Diabetic Nephropathy ◽

Insulin Therapy ◽

Type 1 Diabetes Mellitus ◽

Diabetic Complications ◽

Late Complications ◽

Genetically Engineered ◽

Self Control

All over the world, an increase in type 1 diabetes mellitus is noted annually, along with its late complications. In recent years, more and more information has appeared aimed at the prevention and rehabilitation of children with diabetes. Type 1 diabetes mellitus is a genetically determined disease, in the development of which the main component is an autoimmune process that triggers the destruction of β-cells, which leads to a decrease in insulin production, and subsequently to its absolute insufficiency, the main method of treatment is insulin replacement therapy. To select an adequate dose of insulin, it is necessary to take into account HbA1c, glycemic and glucosuric profiles. Children are advised to use semi-synthetic or genetically engineered insulins. In children, intensified insulin therapy is more often used in the form of a combination of short and medium-acting insulins or ultra-short with prolonged ones. This article presents an analysis of insulin therapy and self-control in children and adolescents with type 1 diabetes mellitus and diabetic nephropathy. It was found that children with diabetic nephropathy approached their illness less responsibly, did not always count bread units and kept records in self-control diaries. Also, this group of children were more likely to receive human insulin with the use of syringe pens. The nutrition of children with diabetes should not be inferior in calories to that of healthy adolescents, while the energy value of the daily diet should be calculated taking into account age, gender, body weight, and energy expenditures. Taking into account the possibility of regression of the initial diabetic complications when the compensation of carbohydrate metabolism is achieved, therapy for type 1 diabetes is a means of preventing the development of severe diabetic complications.

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