medwireNews: Young children with recent onset type 1 diabetes display four unique glycated hemoglobin (HbA1c) trajectories that may be influenced by parental psychosocial factors, US study findings indicate.
The trajectories were derived from an analysis of data from 106 families with children aged 5–9 years (mean 7.5 years) who had been diagnosed with diabetes in the previous 12 months (mean diabetes duration 4.7 months).
During 30 months of follow-up, Susana Patton (Nemours Children’s Clinic-Jacksonville, Florida) and co-investigators observed that, on average, HbA1c levels increased with time, with greater variability during the first versus second half of the study. In addition, mean HbA1c was above the target of 7.5% [58 mmol/mol] at 71% of visits.
Using HbA1c slope, variability, variability ratio, percentage above 7.5%, and density, the researchers identified four HbA1c trajectories in children: high increasing, high stable, intermediate increasing, and low stable.
The high increasing category had the fewest children (n=8) and showed high variability along with the largest slope and an average of 71% of HbA1c values above target.
The high stable trajectory was the largest cluster (n=41). This group had HbA1c values above 7.5% at 90% of visits, on average, and there was minimal change over time.
The intermediate increasing cluster comprised 30 children with a modest HbA1c slope and modest variability. In this group, mean HbA1c was above target at a mean 81% of visits.
Finally, the low stable trajectory included 27 children with a mean 32% of HbA1c levels above target and low variability overall.
As part of the study, parents completed questionnaires to assess variables including diabetes distress (Problem Areas in Diabetes-Parent Revised), fear of hypoglycemia (Hypoglycaemia Fear Survey for Parents), and family conflict (Diabetes Family Conflict Scale-Revised).
Using the responses to these questionnaires, the researchers found that higher levels of immediate diabetes distress were associated with a significantly lower likelihood of a child having a high increasing trajectory relative to a low stable trajectory.
Higher levels of hypoglycemia fear were associated with significantly lower odds for either a high stable or intermediate increasing trajectory versus a low stable trajectory.
“It is possible these associations emerged because parents perceived heightened vulnerability to child hypoglycaemia and therefore were working exceptionally hard to manage their child’s glucose leading to more stable and optimal levels,” Patton et al remark.
In addition, greater diabetes conflict was associated with a significantly increased likelihood of an intermediate increasing rather than low stable trajectory, which the researchers say may identify “conflict as [an] early treatable risk factor for less optimal child HbA1c levels.”
Writing in Diabetic Medicine, Patton and co-authors conclude that their “study provides evidence for tailoring behavioural interventions to families of young school-age children at the highest risk for an increasing or high stable HbA1c trajectory soon after diagnosis.”
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