medwireNews: The risk for acute and chronic diabetes complications associated with poor glucose control is highest among young adults with type 1 diabetes and decreases with age even when the level of glycemic control is equally poor in the older age groups, real-world study data show.
Fang Liz Zhou (Sanofi, Bridgewater, New Jersey, USA) and co-investigators say their data show that stratifying patients by age is “informative because comparisons made strictly on the basis of HbA1c [glycated hemoglobin] control may be confounded by age.”
The findings are based on an analysis of electronic health record data from the 12-month baseline period of the T1PCO study.
Among the 31,430 people with type 1 diabetes included in the analysis, the mean HbA1c was 8.3% and just 20% of participants were below the target of 7.0%.
The researchers report in Diabetes Care that the proportion of people with an HbA1c below 7.0% increased substantially with age, from 12% among those aged 18–25 years to 19%, 22%, and 29% among those aged 26–49, 50–64, and 65 years and older, respectively.
Conversely as age increased mean HbA1c decreased, from 9.4% at age 20 years to 7.8% at age 65 years.
Zhou and team found that the annual incidence of hospitalization for severe hypoglycemia was highest among patients with a mean HbA1c of 9.0% or higher, at 8.3%. By comparison, it was 4.2% among patients with an HbA1c below 7.0% and 4.0% for those with an HbA1c of 7.0% to less than 9.0%.
Furthermore, the relative risk (RR) for severe hypoglycemia among individuals with an HbA1c of 9.0% or higher versus below 7.0% was highest in the youngest participants, at 3.7 for those aged 18–25 years, and then typically fell with age to 2.2, 1.5, and 1.6, for those aged 26–49, 50–64, and 65 years and older, respectively.
This suggests that the “impact of poor glycemic control on [severe hypoglycemia] incidence was more pronounced among younger patients,” Zhou et al remarked.
The investigators observed a similar pattern for diabetic ketoacidosis (DKA), with annual incidence rates of 1.3%, 2.8%, and 15.8% among participants with HbA1c levels below 7.0%, from 7.0% to less than 9.0%, and 9.0% or higher, respectively. The RRs for DKA in the highest versus lowest HbA1c cohorts were 12.7, 11.9, 6.2, and 6.1 in the 18–25, 26–49, 50–64, and 65 years and older age groups, respectively.
Individuals with poor (HbA1c ≥9.0%) versus good (HbA1c <7.0%) glycemic control also had higher prevalence of neuropathy (13.0 vs 9.0%) and nephropathy (11.0 vs 9.0%), both overall and in each age group.
Zhou et al point out that approximately 40% of participants did not see an endocrinologist during the baseline period, which they say highlights “the need to educate primary care physicians, who may be the point of care for these patients.”
They conclude that their results “suggest that in adults with type 1 diabetes, glycemic control is worse than previously estimated and rates of both acute and chronic complications increase with increasing HbA1c.”
By Laura Cowen
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