title: 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.
abstract: 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.
authors.affiliation: Department of Pediatric Endocrinology, Yale University, New Haven, Connecticut.
authors.forename: Eda
authors.initials: E
authors.lastname: Cengiz
authors.affiliation: Jaeb Center for Health Research, Tampa, Florida.
authors.forename: Peiyao
authors.initials: P
authors.lastname: Cheng
authors.affiliation: Jaeb Center for Health Research, Tampa, Florida.
authors.forename: Katrina J
authors.initials: KJ
authors.lastname: Ruedy
authors.affiliation: Jaeb Center for Health Research, Tampa, Florida.
authors.forename: Craig
authors.initials: C
authors.lastname: Kollman
authors.affiliation: Department of Pediatric Endocrinology, Yale University, New Haven, Connecticut.
authors.forename: William V
authors.initials: WV
authors.lastname: Tamborlane
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado, Department of Pediatrics, Aurora, Colorado.
authors.forename: Georgeanna J
authors.initials: GJ
authors.lastname: Klingensmith
authors.affiliation: Jaeb Center for Health Research, Tampa, Florida.
authors.forename: Robin L
authors.initials: RL
authors.lastname: Gal
authors.affiliation: Pediatric Endocrinology, University of Florida, Gainesville, Florida.
authors.forename: Janet
authors.initials: J
authors.lastname: Silverstein
authors.affiliation: Pediatric Endocrinology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Joyce
authors.initials: J
authors.lastname: Lee
authors.affiliation: Pediatric Diabetes and Endocrinology Section, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Redondo
authors.affiliation: Jaeb Center for Health Research, Tampa, Florida.
authors.forename: Roy W
authors.initials: RW
authors.lastname: Beck
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D016883:Diabetic Ketoacidosis / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D018450:Disease Progression; D016903:Drug Monitoring; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000378:metabolism / Q000627:therapeutic use*; D000078790:Insulin Secretion; D050417:Insulin-Secreting Cells / Q000187:drug effects / Q000378:metabolism; D008297:Male; D011446:Prospective Studies; D012306:Risk; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: 
  HbA1c or glycemic control; children; diabetes; type 1