title: Age at diagnosis predicts deterioration in glycaemic control among children and adolescents with type 1 diabetes.
abstract: BACKGROUND
  Poor glycemic control early in the course of type 1 diabetes mellitus (T1DM) increases the risk for microvascular complications. However, predictors of deteriorating control after diagnosis have not been described, making it difficult to identify high-risk patients and proactively provide aggressive interventions.
  
  
  OBJECTIVE
  We examined whether diagnostic age, gender, and race were associated with deteriorating glycemic control during the first 5 years after diagnosis.
  
  
  METHODS
  2218 pediatric patients with T1DM.
  
  
  METHODS
  We conducted a longitudinal cohort study of pediatric patients with T1DM from the Midwest USA, 1993-2009, evaluating within-patient glycated hemoglobin (HbA1c) trajectories constructed from all available HbA1c values within 5 years of diagnosis.
  
  
  RESULTS
  52.6% of patients were male; 86.1% were non-Hispanic Caucasian. The mean diagnostic age was 9.0±4.1 years. The mean number of HbA1c values/year/participant was 2.4±0.9. HbA1c trajectories differed markedly across age groups, with older patients experiencing greater deterioration than their younger counterparts (p<0.001). HbA1c trajectories, stratified by age, varied markedly by race (p for race×diagnostic age <0.001). Non-Hispanic African-American patients experienced higher initial HbA1c (8.7% vs 7.6% (71.6 vs 59.6 mmol/mol); p<0.001), and greater deterioration in HbA1c than non-Hispanic Caucasian patients across diagnostic ages (rise of 2.04% vs 0.99% per year (22.3 vs 10.8 mmol/mol/year); p<0.0001).
  
  
  CONCLUSIONS
  Older diagnostic age and black race are major risk factors for deterioration in glycemic control early in the course of T1DM. These findings can inform efforts to explore the reasons behind these differences and develop preventive interventions for high-risk patients.
authors.affiliation: Children's Mercy Hospitals and Clinics , Kansas City, Missouri , USA ; University of Missouri-Kansas City , Kansas City, Missouri , USA ; University of Kansas Medical Center , KansasCity, Kansas , USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Clements
authors.affiliation: Institute of Medicine, University of Gothenburg , Gothenburg , Sweden.
authors.forename: Marcus
authors.initials: M
authors.lastname: Lind
authors.affiliation: Children's Mercy Hospitals and Clinics , Kansas City, Missouri , USA ; University of Missouri-Kansas City , Kansas City, Missouri , USA.
authors.forename: Sripriya
authors.initials: S
authors.lastname: Raman
authors.affiliation: University of Kansas Medical Center , KansasCity, Kansas , USA.
authors.forename: Susana R
authors.initials: SR
authors.lastname: Patton
authors.affiliation: Yale University School of Medicine , New Haven, Connecticut , USA.
authors.forename: Kasia J
authors.initials: KJ
authors.lastname: Lipska
authors.affiliation: Children's Mercy Hospitals and Clinics , Kansas City, Missouri , USA ; University of Missouri-Kansas City , Kansas City, Missouri , USA.
authors.forename: Amanda G
authors.initials: AG
authors.lastname: Fridlington
authors.affiliation: Saint Luke's Mid America Heart Institute , Kansas City, Missouri , USA.
authors.forename: Fengming
authors.initials: F
authors.lastname: Tang
authors.affiliation: Saint Luke's Mid America Heart Institute , Kansas City, Missouri , USA.
authors.forename: Phil G
authors.initials: PG
authors.lastname: Jones
authors.affiliation: Children's Mercy Hospitals and Clinics , Kansas City, Missouri , USA.
authors.forename: Yue
authors.initials: Y
authors.lastname: Wu
authors.affiliation: University of Missouri-Kansas City , Kansas City, Missouri , USA ; Saint Luke's Mid America Heart Institute , Kansas City, Missouri , USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: University of Missouri-Kansas City , Kansas City, Missouri , USA ; Saint Luke's Mid America Heart Institute , Kansas City, Missouri , USA.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Kosiborod
keywords: Adolescents / Children; Age of Diabetes Onset; Glycemic Control; Type 1