Tracking of Metabolic Control from Childhood to Young Adulthood in Type 1 Diabetes

Objective This prospective longitudinal survey was designed to follow patients with diabetes from disease onset in childhood over an extended period of time including puberty until young adulthood with respect tometabolic control. Study design An electronic diabetes patient documentation system used in diabetes centers in Austria and Germany was utilized for standardized data collection. Complete documentation of metabolic control for prepuberty (<= 13 years), puberty (14-19 years), and adulthood (>= 20 years) was available in 1146 patients. Results Median age at diabetesmanifestation was 7.2 (IQR4.7-9.4) years; 49% weremale. In the prepubertal stage, median glycated hemoglobin A1c (HbA1c) was 7.5 (IQR6.8-8.3), during puberty 8.0 (IQR7.3-8.9), and after puberty 7.8 (IQR 7.1-9.0). A significant intra-individual correlation was found for prepuberty to puberty HbA1c levels (R = 0.55, P < .001), puberty to adulthood (R = 0.59, P < .001), as well as prepuberty to adulthood (R = 0.30, P < .001). When patients were divided into tertiles of prepubertal HbA1c, HbA1c increased in all 3 groups over time, however, significant group differences tracked into adulthood (P < .001 at all stages). Aregressionmodel identified pre-pubertalHbA1c as a significant and relevant predictor of metabolic control in young adulthood adjusted for confounders (P < .001). Conclusions This survey provides evidence for long-term tracking of metabolic control from childhood until adulthood, suggesting an early focus on metabolic control.