Improvement in A1cLevels in Early Adulthood in the T1D Exchange: Impact of Racial, Socioeconomic, and Clinical Factors

Abstract

Context: Glycemic control in adolescents with type 1 diabetes is poor; yet, it typically improves during early adulthood. Factors related to improvement of glycemic control are unclear. Objective: This work examines how demographic and clinical variables may affect trajectories of glycemic control over time. Methods: This retrospective, observational study comprised 1775 participants ages 18 to 30 years at enrollment in the T1D Exchange clinic registry. Latent class trajectory modeling was used to determine subgroups following a similar glycated hemoglobin A1c (HbA1c) trajectory over time. Results: Five distinct trajectories of HbA1c classes were identified: "low-decline"and "moderate-decline"groups had low or moderate HbA1c with a gradual decline, the "high-stable"group had high HbA1c and remained stable, and the "very high-rapid decline"and "very high-slow decline"groups had very high HbA1c with rapid or gradual decline. Compared with the "high-stable"group, the "low-decline"and "moderate-decline"groups were more likely to be male (P=.009), White non-Hispanic (P=.02), nonsmokers (P