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Trajectories in HbA1c and other risk factors among adults with type 1 diabetes by age at onset.

Authors
  • Edqvist, Jon1, 2
  • Rawshani, Araz1, 2
  • Rawshani, Aidin1, 2
  • Adiels, Martin1, 3
  • Franzén, Stefan4
  • Bjorck, Lena1, 2
  • Svensson, Ann-Marie4
  • Lind, Marcus1, 5
  • Sattar, Naveed6
  • Rosengren, Annika7, 2
  • 1 Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Västra Götaland, Sweden. , (Sweden)
  • 2 Region Västra Götaland, Sahlgrenska University Hospital, Goteborg, Sweden. , (Sweden)
  • 3 Department of Public Health and Community Medicine, University of Gothenburg Health Metrics Unit, Gothenburg, Sweden. , (Sweden)
  • 4 National Diabetes Register, Centre of Registers, Gothenburg, Sweden. , (Sweden)
  • 5 Medicine, Uddevalla Hospital, Uddevalia, Region of Vastra Gotaland, Sweden. , (Sweden)
  • 6 BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK.
  • 7 Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Västra Götaland, Sweden [email protected] , (Sweden)
Type
Published Article
Journal
BMJ Open Diabetes Research & Care
Publisher
BMJ
Publication Date
May 01, 2021
Volume
9
Issue
1
Identifiers
DOI: 10.1136/bmjdrc-2021-002187
PMID: 34059526
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

In type 1 diabetes, potential loss of life-years is greatest in those who are youngest at the time of onset. Using data from a nationwide cohort of patients with type 1 diabetes, we aimed to study risk factor trajectories by age at diagnosis. We stratified 30 005 patients with type 1 diabetes aged 18-75 years into categories based on age at onset: 0-10, 11-15, 16-20, 21-25, and 26-30 years. HbA1c, albuminuria, estimated glomerular filtration rate (eGFR), body mass index (BMI), low-denisty lipoprotein (LDL)-cholesterol, systolic blood pressure (SBP), and diastolic blood pressure trends were analyzed using mixed models. Variable importance for baseline HbA1c was analyzed using conditional random forest and gradient boosting machine approaches. Individuals aged ≥16 years at onset displayed a relatively low mean HbA1c level (~55-57 mmol/mol) that gradually increased. In contrast, individuals diagnosed at ≤15 years old entered adulthood with a mean HbA1c of approximately 70 mmol/mol. For all groups, HbA1c levels stabilized at a mean of approximately 65 mmol/mol by about 40 years old. In patients who were young at the time of onset, albuminuria appeared at an earlier age, suggesting a more rapid decrease in eGFR, while there were no distinct differences in BMI, SBP, and LDL-cholesterol trajectories between groups. Low education, higher age, and poor risk factor control were associated with higher HbA1c levels. Young age at the diabetes onset plays a substantial role in subsequent glycemic control and the presence of albuminuria, where patients with early onset may accrue a substantial glycemic load during this period. © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

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