The relationship between glycemic control and age of onset in type I diabetes

This study evaluated the association between age of onset and glycemic control in patients with type I diabetes mellitus. 

Type I diabetes mellitus is an autoimmune disease in which there is an ongoing destruction of beta cells (cells found in the pancreas that produce insulin). The disease is characterized by an abrupt onset of symptoms such as thirst and excessive urination, weight loss and elevated blood glucose levels (hyperglycemia), followed by progression to an absolute insulin deficiency at 5 -10 years from diagnosis. This means that glycemic control therefore depends on the best possible insulin replacement therapy. Glycemic control is assessed by the blood level of glycated hemoglobin (HbA1c). HbA1c levels indicate what percentage of the body’s hemoglobin (oxygen-carrying protein) is coated in sugar, with higher results specifying poorer blood glucose control. HbA1c level below 6.5% indicate efficient glycemic control. 

 This study aimed to use HbA1c levels to determine the relationship between age of onset of type I diabetes and the progression of glycemic control. 

This study included 716 patients with type I diabetes from different age groups. During an average follow up period of 10 years, the average HbA1c blood level of each patient was calculated annually.

Results showed that patients under the age of 20 years at disease onset and adults aged over 40 years had the worst glycemic control.

HbA1c levels did not increase in a constant rate with each year. For instance, patients aged 10- 14 years at onset plateaued (reached a state of little or no change) at an average HbA1c level of about 8.4% in the seventh year of follow up. This was followed by a mild decline in HbA1c levels. In contrast, patients with disease onset over age 15 plateaued in 3-4 years. While younger adults (21 – 44) generally plateaued at 8% HbA1c, the 45-59 age group, who generally had higher HbA1c at presentation than younger adults, plateaued close to 9% by the end of follow up.

There were no gender differences in glycemic control development in any of age groups.

This article showed a significant variance across all age groups in regards to glycemic control at time of diagnosis and during the progression of the disease. This highlights the need for increased glycemic monitoring in some age groups. 

This study was retrospective and had a small number of patients for some of the older age groups. 

Discuss methods of achieving glycemic control with your physician.