Glycemic control in adolescents with type 1 diabetes (T1D) is poor; however, it typically improves during early adulthood. Factors related to improvement of glycemic control are unclear. A total of 1,775 participants aged 18-30 years at enrollment in the T1D Exchange Registry followed for an average of 6 years were included in this analysis. Latent class trajectory modeling was used to determine sub-groups following a similar HbA1c trajectory over time. Five distinct trajectories of HbA1c classes were identified: Groups 1 and 2 had low or moderate HbA1c with a gradual decline with age, Group 3 had high HbA1c and remained stable, and Groups 4 and 5 had very high HbA1c with rapid or gradual decline (Figure). Compared with Group 3, Groups 1 and 2 were more likely to be male (P = 0.01), white non-Hispanic (P = 0.02), non-smokers (P = 0.001), check glucose more frequently (P < 0.001), and have higher education (P < 0.001), lower BMI (P = 0.01), and lower daily insulin dose (P < 0.001); if female, those in Group 1 were more likely to have a pregnancy during the time observed (P = 0.04). Group 4 was more likely to increase number of SMBG checks (P = 0.02) and have BMI increase over time (P = 0.02) compared with Group 5. We determined 5 distinct patterns of glycemic control from young adulthood into adulthood. Further evaluation into the modifiable factors associated with a declining A1c trajectory would aid in the development of targeted interventions.
E. Toschi: None. R. Bailey: None. K. Miller: None. P. Calhoun: Stock/Shareholder; Self; Dexcom, Inc.
The Leona M. and Harry B. Helmsley Charitable Trust (G-2016PG-T1D053)