medwireNews: Age at type 1 diabetes diagnosis does not appear to affect glycemic control and comorbidity once disease is established, but important differences occur between age groups at the time of diagnosis, US study data show.
Furthermore, regardless of age at diagnosis the proportion of patients achieving target glycated hemoglobin (HbA1c) levels was around just 20% at their most recent measurement, indicating that “optimizing glycemic control remains a challenge in all age groups,” write Lauren Kanapka (Jaeb Centre for Health Research, Tampa, Florida) and co-authors in Diabetic Medicine.
They add: “Continued work needs to be carried out to identify adults with type 1 diabetes earlier and to improve treatment for all those with type 1 diabetes to reach and maintain target blood glucose levels.”
The retrospective analysis included data for 20,660 people (51% women, median age 18 years) with type 1 diabetes. Of these, 57% were diagnosed before the age of 10 years, 26% at age 10–17 years, 6% at age 18–24 years, 7% at age 25–39 years, and 4% at age 40 years or older.
At diagnosis, the researchers found that diabetic ketoacidosis (DKA) was significantly more common among individuals with diabetes onset in childhood, with rates of 40% in those aged younger than 10 years or 10–17 years at diagnosis versus 19% among people diagnosed at age 40 years and older.
By contrast, people diagnosed in childhood were significantly less likely to be overweight or obese at diagnosis than those diagnosed as adults, at rates of 21% versus 42% for the youngest versus oldest age groups.
Increasing age at diagnosis was also associated with a significant increase in the use of oral antidiabetic agents preceding diagnosis, with rates below 1% among those in the youngest age group compared with 57% among those in the oldest age group.
“It is therefore imperative that baseline characteristics other than DKA be considered to classify older individuals with new-onset diabetes appropriately since so many antibody-positive individuals who do not present with DKA are initially misclassified as having type 2 diabetes rather than type 1 diabetes,” Kanapka et al remark.
In a subgroup of 6952 participants aged 25 years or older with a diabetes duration of at least 1 year, the investigators found that insulin pump use at the most recent clinic visit was significantly more common among the participants diagnosed as children rather than adults, with rates decreasing from 62% to 44% across the age groups.
Participants diagnosed as children also had significantly lower high-density lipoprotein cholesterol levels, and significantly higher rates of celiac disease at their last clinic visit than those diagnosed as adults, but the were no differences by age at diagnosis for current BMI, most recent HbA1c, use of continuous glucose monitoring, total daily insulin, or other comorbidities such as thyroid disease, cardiovascular disease, hypertension, nephropathy, and retinopathy.
Kanapka and team therefore conclude: “The data indicate that there is little distinction between the clinical characteristics and outcomes of type 1 diabetes diagnosed in childhood vs adulthood.”
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