We sought to examine trajectories in glycemic control across the transition from adolescence into early adulthood and identify component causes related to co-occurring psychosocial and behavioral changes. The cohort included 48,137 HbA1c values for 10,174 participants (ages 13-25) with T1D (49% female; 51% pump users) enrolled in the T1D Exchange registry. Multivariate mixed effects models were used to identify HbA1c trajectories; interactions between age and predictors were used to quantify how each predictor moderated trajectory shape. Mean HbA1c for the cohort was high (8.66), with only 14.0% meeting the adult target of <7.0%. Key indicators of self-management, including frequency of daily testing and testing before administering insulin, declined steadily into early adulthood while diabetes distress peaked in early 20s; in adjusted analyses, these strongly influenced the shape of HbA1c trajectories (see Figure) whereby increases in HbA1c were exacerbated with suboptimal self-management/distress. These psychosocial and self-management indicators were more influential than treatment regimen for predicting glycemic control. Late adolescence/early adulthood are periods of distinct vulnerability that warrant additional efforts to improve disease control via affecting self-management and distress.
Disclosure
L.E. Wisk: None.
Funding
National Institute of Diabetes and Digestive and Kidney Diseases (1K01DK116932-01)
