Clinical outcomes in youth beyond the first year of type 1 diabetes: Results of the Pediatric Diabetes Consortium (PDC) type 1 diabetes new onset (NeOn) study.

Publisher: Munksgaard Country of Publication: Denmark NLM ID: 100939345 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1399-5448 (Electronic) Linking ISSN: 1399543X NLM ISO Abbreviation: Pediatr Diabetes Subsets: MEDLINE

Original Publication: Copenhagen : Munksgaard, c2000-

Diabetes Mellitus, Type 1/*drug therapy ; Hyperglycemia/*prevention & control ; Hypoglycemia/*prevention & control ; Hypoglycemic Agents/*therapeutic use ; Insulin/*therapeutic use; Academic Medical Centers ; Adolescent ; Child ; Child, Preschool ; Cohort Studies ; Diabetes Mellitus, Type 1/blood ; Diabetes Mellitus, Type 1/physiopathology ; Diabetic Ketoacidosis/epidemiology ; Diabetic Ketoacidosis/physiopathology ; Diabetic Ketoacidosis/prevention & control ; Disease Progression ; Drug Monitoring ; Female ; Follow-Up Studies ; Glycated Hemoglobin/analysis ; Humans ; Hyperglycemia/epidemiology ; Hyperglycemia/physiopathology ; Hypoglycemia/chemically induced ; Hypoglycemia/epidemiology ; Hypoglycemia/physiopathology ; Hypoglycemic Agents/administration & dosage ; Hypoglycemic Agents/adverse effects ; Insulin/administration & dosage ; Insulin/adverse effects ; Insulin/metabolism ; Insulin Secretion ; Insulin-Secreting Cells/drug effects ; Insulin-Secreting Cells/metabolism ; Male ; Prospective Studies ; Risk ; Severity of Illness Index ; United States/epidemiology

Objective: Current data are limited on the course of type 1 diabetes (T1D) in children and adolescents through the first few years of diabetes. The Pediatric Diabetes Consortium T1D new onset (NeOn) Study was undertaken to prospectively assess natural history and clinical outcomes in children treated at 7 US diabetes centers from the time of diagnosis. This paper describes clinical outcomes in the T1D NeOn cohort during the first 3 years postdiagnosis.
Results: A total of 1048 participants (mean age 9.2 years, 49% female, 65% non-Hispanic White) were enrolled between July 2009 and April 2011. Mean glycated hemoglobin (HbA1c) (±SD) was 7.2% (55 mmol/mol) at 3 months, followed by a progressive rise to 8.4% (68 mmol/mol) at 36 months postdiagnosis, with only 30% of participants achieving target HbA1c<7.5% (58 mmol/mol). The percentage of participants in partial remission estimated by insulin dose adjusted HbA1c [HbA1c % + (4×insulin dose unit/kg/24 h)] ≤9 sharply declined from 23% at 12 months to 7% at 36 months. The percentage of participants developing diabetic ketoacidosis (DKA) was 1% in the first year after diagnosis, increasing to 6% in years 2 and 3.
Conclusions: These results demonstrate the gradual decline in glycemic control due to waning residual endogenous insulin secretion with increasing duration of T1D in children and adolescents. These data indicate the need to translate recent advances in automated insulin delivery, new insulin analogs, and adjunctive pharmacologic agents into novel treatment strategies to maintain optimal glycemic control even early in the course of T1D.
(© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

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UL1 TR001863 United States TR NCATS NIH HHS; P60 DK020572 United States DK NIDDK NIH HHS; P30 DK045735 United States DK NIDDK NIH HHS; P30 DK020572 United States DK NIDDK NIH HHS; KL2 TR001862 United States TR NCATS NIH HHS

Keywords: HbA1c or glycemic control; children; diabetes; type 1

0 (Glycated Hemoglobin A)
0 (Hypoglycemic Agents)
0 (Insulin)
0 (hemoglobin A1c protein, human)

Date Created: 20161021 Date Completed: 20180620 Latest Revision: 20221207

20231215

PMC5397378

10.1111/pedi.12459

27758023