title: HbA(1c) levels in schoolchildren with type 1 diabetes are seasonally variable and dependent on weather conditions.
abstract: OBJECTIVE
  We evaluated seasonal HbA(1c) changes in children with type 1 diabetes and its relation with measures of weather conditions.
  
  
  METHODS
  HbA(1c) changes over more than 3 years were evaluated in type 1 diabetic patients who were younger than 18 years and had diabetes duration of more than 12 months, and correlated with measures of weather conditions (ambient temperature, hours of sunshine and solar irradiance). After comparison of autocorrelation patterns, patterns of metabolic control and meteorological data were evaluated using Spearman rank correlation.
  
  
  RESULTS
  A total of 3,935 HbA(1c) measurements in 589 school (≥ 7 years) and 88 preschool (<7 years) children were analysed. Mean (± SD) HbA(1c) level for the whole study period was 7.65 ± 1.12%. The lowest HbA(1c) levels were observed in late summer and the highest in winter months, with differences consistently exceeding 0.44%. Autocorrelation analysis of HbA(1c) levels in schoolchildren showed a sine-wave pattern with a cycle length of roughly 12 months, which mirrored changes in ambient temperature. Strong negative correlations of HbA(1c) with ambient temperature (R = -0.56; p = 0.0002), hours of sunshine (R= -0.52; p = 0.0007) and solar irradiance (R = -0.52; p = 0.0006) were present in schoolchildren, but not in preschoolers (p ≥ 0.29 for each correlation).
  
  
  CONCLUSIONS
  Seasonal changes of HbA(1c) levels in schoolchildren with type 1 diabetes are a significant phenomenon and should be considered in patient education and diabetes management. They may potentially affect the results of clinical trials using HbA(1c) levels as their primary outcome, as well as HbA(1c)-based diagnosis of diabetes.
authors.affiliation: Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, 36/50 Sporna St, 91-738 Lodz, Poland.
authors.forename: B
authors.initials: B
authors.lastname: Mianowska
authors.forename: W
authors.initials: W
authors.lastname: Fendler
authors.forename: A
authors.initials: A
authors.lastname: Szadkowska
authors.forename: A
authors.initials: A
authors.lastname: Baranowska
authors.forename: E
authors.initials: E
authors.lastname: Grzelak-Agaciak
authors.forename: J
authors.initials: J
authors.lastname: Sadon
authors.forename: H
authors.initials: H
authors.lastname: Keenan
authors.forename: W
authors.initials: W
authors.lastname: Mlynarski
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D012621:Seasons; D014887:Weather
chemical_list: D006442:Glycated Hemoglobin