Early glycemic control sets life course for type 1 diabetes patients
medwireNews: The degree of glycemic control that patients with type 1 diabetes achieve during the first 4 to 5 years after diagnosis may set the long-term pattern, research suggests.
This suggests the existence of “a 5 year window during which longer-term HbA1c [glycated hemoglobin] and therefore risk of diabetes complications is determined,” say Parth Narendran (University Hospitals Birmingham NHS Foundation Trust, UK) and co-researchers.
Patients may benefit from “urgent and appropriate targeting of therapies” during this period, they say, potentially in the form of “a newly diagnosed type 1 diabetes pathway with structured education and aggressive glucose control.”
The study included 4525 UK residents diagnosed with type 1 diabetes during 1995–2015 and included in The Health Improvement Network (THIN) database. Their average baseline HbA1c increased sharply over the first 5 years after diagnosis, from around 68 to 75 mmol/mol and remained relatively stable thereafter for up to 10 years of follow-up.
The largest difference from the HbA1c level at which patients eventually settled occurred during the first year after diagnosis (7.0 mmol/mol; 0.6%), and HbA1c levels remained significantly below long-term levels until 4–5 years after diagnosis. This pattern remained after accounting for age, sex, and socioeconomic status (Townsend index), and when the team restricted the analysis to patients with at least 10 years of data (n=938).
The researchers believe that some of the rise in HbA1c during the first 5 years after diagnosis may be explained by the continuing loss of C-peptide. But they say that patient-related factors may also play an important role.
“Habituation of the day to day approach to managing chronic disease can make any long-lasting change difficult,” Narendran and team write in Diabetologia.
They believe this may help to explain why long-term HbA1c levels appeared resistant to change, despite being, on average, well above target levels from 5 years onwards.
The speed at which HbA1c levels settled at their long-term level varied by age, tending to settle faster in adults (around 2 to 6 years after diagnosis) than in children (6 to 10 years after diagnosis), and there were also some sex differences, with males’ HbA1c levels settling earlier than females’ among those younger than 10 or older than 30 years, and later in the 10–20-year age category.
The researchers also highlight the need to explore whether later interventions can change the long-term track of glycemic control, saying there is currently no evidence to support a focused intervention at this stage “and this clinical need becomes even more evident in light of the study findings.”
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