Predictors of glycemic control and short-term adverse outcomes in youth with type 1 diabetes.
OBJECTIVE
To examine predictors of glycemic control and to assess how glycemic control affects the incidence of short-term adverse outcomes in a pediatric population with type 1 diabetes.


METHODS
Three hundred youth, aged 7 to 16 years, with type 1 diabetes who were receiving diabetes specialty care were followed up prospectively for 1 year. Treatment plans and frequency of adverse outcomes were ascertained by questionnaires and medical record review. Incidence rates of adverse outcomes were compared among 3 strata of the population, representing tertiles of baseline glycosylated hemoglobin (HbA1c).


RESULTS
Blood glucose monitoring frequency was the sole modifiable predictor of HbA1c (P <.0001). Overall incidence rate of hospitalization was 13 per 100 person-years, more than 3 times the rate in the general pediatric population and significantly higher in the upper HbA1c tertile compared with the other strata (P =.001). Rate of emergency department use was 29 per 100 person-years and did not differ significantly among tertiles. Incidence of severe hypoglycemia was 62 per 100 person-years and notably high even in those with poorest glycemic control.


CONCLUSIONS
Despite improvements in diabetes care, the incidence of short-term adverse events in children with type 1 diabetes remains high, particularly in those with poorest glycemic control.
Levine
B S
BS
Pediatric and Adolescent Unit and the Section of Genetics and Epidemiology, Joslin Diabetes Center, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
Anderson
B J
BJ
Butler
D A
DA
Antisdel
J E
JE
Brackett
J
J
Laffel
L M
LM
D000293:Adolescent; D015190:Blood Glucose Self-Monitoring; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications* / Q000188:drug therapy; D016883:Diabetic Ketoacidosis / Q000209:etiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006442:Glycated Hemoglobin / Q000187:drug effects*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology; D007328:Insulin / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011795:Surveys and Questionnaires
D006442:Glycated Hemoglobin; D007328:Insulin