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ADA: Teenagers with Type 1 Diabetes Not Even Close to Meeting Goals

One in 5 kids with diabetes has an A1C above 10%…. 

According to results of the TEENs Registry Study, presented at the American Diabetes Association 2014 Scientific Sessions, 75 percent of young people living with type 1 diabetes are not meeting the recommended glycemic goals.

The TEENs study, funded by Sanofi, was one of the largest studies to ever assess type 1 diabetes management and the factors that affect it.

Commenting on the study was Dr. Lori M.B. Laffel, chief of the pediatric, adolescent and young adult section of the Joslin Diabetes Center and associate professor of pediatrics at Harvard Medical School in Boston, Massachusetts. Dr. Laffel said in her presentation of the results, "Despite modern advances in insulin replacement, the majority of young patients still fail to achieve recommended glycemic targets. In addition many continue to experience acute complications including both hypoglycemia and diabetic ketoacidosis."

The data was collected from 5,960 participants between the ages of 8 and 25 seen at 219 diabetes centers in 20 developing and developed countries including Europe, the United States, Latin America, the Middle East, Africa and India. The patients had a mean age of 15 and a mean disease duration of 7 years. 75% of participants were white and between 26% and 29% were clinically overweight or obese. Average A1C levels were 8.3% for the 1724 children ranging in age from 8 to 12, 8.6% for the 2854 participants between the ages of 13 and 18 and 8.4% for the 1382 young adults aged 19 to 25. Overall 72% of participants were not meeting recommended A1C targets; less than 7.5% for those 18 or younger and less than 7% for diabetics between the ages of 19 and 25.

Rates of DKA and severe hypoglycemia were higher among the young adults than either the teens or the children. 5.6% of patients in the 8 to 12 age group reported at least 1 episode of DKA in the previous 3 months compared to 6.6% of those 19 to 25. Severe hypoglycemia was similar at 2.2% compared to 4.1% for the teens and young adults, respectively. DKA was more common among those whose A1C levels were consistently above target. Interestingly, hypoglycemia was also more common in those groups above their target.

An analysis, adjusted for age and global region, found demographic factors associated with achieving A1C goals were age 8 to 12 vs. 19 to 25 (2.5-fold difference) and diagnosis of type 1 diabetes at age 12 or older vs less than 6 years (1.7 fold difference).

Treatment factors that predicted target achievement were: performing 5 or more glucose tests a day vs less than 3 tests (2-fold difference); carbohydrate counting vs. avoiding sugar; pump vs. injection, no DKA vs DKA in the past 3 months (2-fold difference) and having glucagon in the home vs not.

Psychosocial predictive factors included family conflict, diabetes related financial burden, and living with 2 parents in the home vs. not. Dr. Laffel believes that targeting modifiable risk factors is important in successful intervention of patients who are unable to reach their target A1C. Providing added support and education to youth with non-modifiable risk factors such as demographics may also help kids reach their targets.

Joseph I. Wolfsdorf, MD, clinical director of the division of endocrinology at Boston Children’s Hospital and professor of pediatrics at Harvard Medical School commented that, "Certain things are not modifiable. If you’re not a 2-parent family, we can’t fix that…I think we have minimal ability to significantly affect psychosocial dysfunction within families. If we recognize it, we can try to have the patient and parents meet with a psychologist or social worker and work through the issues. I don’t know how big an impact that has"…."But it’s still worth doing", he went on to say. "We should try to identify it, and if you have the resources, steer patients and families toward that kind of help."

Practice Pearls:
  • Overall 72% of participants were not meeting recommended A1C targets; less than 7.5% for those 18 or younger and less than 7% for diabetics between the ages of 19 and 25.
  • Targeting modifiable risk factors is important in successful intervention of patients who are unable to reach their target A1C.
  • Providing added support and education to youth with non-modifiable risk factors such as demographics may also help kids reach their targets.

Tucker, Miriam E., TEENs: Most Youth with Type 1 Diabetes Miss Glycemic Goals. American Diabetes Association 2014 Scientific Sessions; June 13, 2014. Abstract32-OR, Abstract 259-OR