Issue 127 Item 1 Optimize Control of Type 1 Diabetes From Start

More aggressive treatment for the newly diagnosed provide better outcomes in the future Optimal control of type 1 diabetes in children should be a priority from the time of diagnosis, two speakers said at the annual scientific sessions of the American Diabetes Association.

Findings from a German study suggest that hemoglobin A1c (HbA1c) levels achieved in prepubertal children with type 1 diabetes strongly predict metabolic control in adulthood, while an Italian group found that institution of insulin pump therapy at the time of diagnosis may provide the best outcome.

Dr. Matthias Grabert of the University of Ulm (Germany) reported on 166 children at 15 centers who were diagnosed with type 1 diabetes prior to puberty, then followed for 10 or more years into adulthood. Over 7,000 HbA1c values, taken at 3.5-month intervals, were analyzed. During the first 2 years following diagnosis, average HbA1c levels were 7.5%, increasing to 7.8% for the rest of the prepubertal period; 8.6% during puberty; and 8.5% in early adulthood (beyond 18 years).

There was a strong association between the prepubertal HbA1c values beyond the first 2 years and adulthood. As expected, values in the lowest quartile increased the most, from an average of 6.3% to 7.5%, while the other groups barely shifted. Patients in the second quartile during prepuberty had average HbA1c levels of 7.3% in adulthood, those in the third quartile had average levels of 8.0%, and those in the highest quartile had average levels of 9.8%, Dr. Grabert reported.

Only 26% of the subjects shifted from one quartile to another between prepuberty and adulthood. Average HbA1c levels were significantly different between the 15 centers, but the same trend was seen at each one.

The findings suggest that patients tend to fall into individual “tracks” of metabolic control early on, Dr. Grabert said. “We need to put patients on the best track as early as possible, because it’s hard to change [to a different track] later.” Presented at scientific sessions of the ADA