Longitudinal Trajectories of MetabolicControl From Childhood to Young Adulthood in Type 1 Diabetes From a Large German/Austrian Registry: A Group-Based Modeling Approach

被引：91

作者：

Schwandt, Anke ^{[1
,2
]}

Hermann, Julia M. ^{[1
,2
]}

Rosenbauer, Joachim ^{[2
,3
]}

Boettcher, Claudia ^{[4
]}

Dunstheimer, Desiree ^{[5
]}

Grulich-Henn, Juergen ^{[6
]}

Kuss, Oliver ^{[2
,3
]}

Rami-Merhar, Birgit ^{[7
]}

Vogel, Christian ^{[8
]}

Holl, Reinhard W. ^{[1
,2
]}

机构：

[1] Univ Ulm, Inst Epidemiol & Med Biometry ZIBMT, Ulm, Germany

[2] German Ctr Diabet Res DZD, Neuherberg, Germany

[3] Heinrich Heine Univ Dusseldorf, Leibniz Ctr Diabet Res, German Diabet Ctr, Inst Biometr & Epidemiol, Dusseldorf, Germany

[4] Justus Liebig Univ, Ctr Child & Adolescent Med, Div Pediat Endocrinol & Diabetol, Giessen, Germany

[5] Clin Ctr Augsburg, Dept Pediat, Augsburg, Germany

[6] Heidelberg Univ, Dept Pediat, Heidelberg, Germany

[7] Med Univ Vienna, Dept Pediat & Adolescent Med, Vienna, Austria

[8] Childrens Hosp Chemnitz, Dept Pediat, Chemnitz, Germany

来源：

DIABETES CARE | 2017年 / 40卷 / 03期

关键词：

GLYCEMIC CONTROL TRAJECTORIES; CARDIOVASCULAR RISK-FACTORS; BODY-MASS INDEX; PHYSICAL-ACTIVITY; ADOLESCENTS; CHILDREN; MULTICENTER; GROWTH; IMPACT; STATEMENT;

D O I：

10.2337/dc16-1625

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

OBJECTIVE Worsening of glycemic control in type 1 diabetes during puberty is a common observation. However, HbA1c remains stable or even improves for some youths. The aim is to identify distinct patterns of glycemic control in type 1 diabetes from childhood to young adulthood. RESEARCH DESIGN AND METHODS A total of 6,433 patients with type 1 diabetes were selected from the prospective, multicenter diabetes patient registry Diabetes-Patienten-Verlaufsdokumentation (DPV) (follow-up from age 8 to 19 years, baseline diabetes duration >= 2 years, HbA(1c) aggregated per year of life). We used latent class growth modeling as the trajectory approach to determine distinct subgroups following a similar trajectory for HbA(1c) over time. RESULTS Five distinct longitudinal trajectories of HbA1c were determined, comprising group 1 = 40%, group 2 = 27%, group 3 = 15%, group 4 = 13%, and group 5 = 5% of patients. Groups 1-3 indicated stable glycemic control at different HbA(1c) levels. At baseline, similar HbA(1c) was observed in group 1 and group 4, but HbA(1c) deteriorated in group 4 from age 8 to 19 years. Similar patterns were present in group 3 and group 5. We observed differences in self-monitoring of blood glucose, insulin therapy, daily insulin dose, physical activity, BMI SD score, body-height SD score, and migration background across all HbA(1c) trajectories (all P = 0.001). No sex differences were present. Comparing groups with similar initial HbA1c but different patterns, groups with higher HbA(1c) increase were characterized by lower frequency of self-monitoring of blood glucose and physical activity and reduced height (all P < 0.01). CONCLUSIONS Using a trajectory approach, we determined five distinct longitudinal patterns of glycemic control from childhood to early adulthood. Diabetes self-care, treatment differences, and demographics were related to different HbA(1c) courses.

引用

页码：309 / 316

页数：8

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