Early glycaemic control is predictive of long-term control: A retrospective observational study

Abstract

There is a paucity of long-term data examining the relationship between early glycaemic control, in children and young people diagnosed with type 1 diabetes mellitus (T1DM), and long-term control. We wanted to determine whether early glycaemic control can predict long-term control. In addition, we examined whether initial presentation with ketoacidosis predicts future control. A retrospective observational study of 155 children diagnosed with T1DM was undertaken examining HbA1c values collected over a 14-year period (1990-2004). HbA1c levels at diagnosis, over the first year after diagnosis and subsequent HbA1c were analysed by Pearson Correlation and multiple regression analysis to determine whether early glycaemic control is predictive of future, long-term control. The cohort of 155 (81 male) currently aged between 2.4-18.3 years had a mean age at diagnosis of 6.6 years, with a mean duration of diabetes of 5.0 years. HbA1c levels at diagnosis (correlation coefficient 0.351, p<0.05) and within the first year (correlation coefficient 0.438, p<0.001) were significant predictors of long-term control; diabetic ketoacidosis at presentation had no predictive value (correlation coefficient -0.096, p=0.326). Multiple regression analysis indicated that the mean HbA1c level within the first year was the best predictor of the long-term HbA 1c (r2=0.471). Early glycaemic control is predictive of long-term control. Health professionals seek to identify critical points in the evolution of T1DM at which to intervene in the hope of improving outcome, and this study identifies the first year as such a critical time. Copyright © 2013 John Wiley & Sons.