Glycemic control of adolescents and young adults with type 1 diabetes across Australia and New Zealand.

Abstract

Introduction: Many adolescents and young adults with type 1 diabetes (T1D) move away from supportive parental homes, have less structure in their lives and engage in behaviors which may be detrimental to their diabetes care. Objective(s): We examined the glycemic control of young people with T1D across Australasia, on whom there is a paucity of published data. Method(s): We used data from ADDN (addn.org.au), a collaboration among pediatric and adult diabetes centers across Australasia. Longitudinal data were extracted on all healthcare visits attended by young people with T1D who were aged 16-25 yrs at their last visit. Clinical data were extracted from 1st Jan 2014-31st Dec 2018 inclusive. Result(s): A cohort of 4651 young people attending 17 diabetes centers across Australasia met the inclusion criteria; 2433 (52%) were male. Mean+SD T1D duration was 8.6+4.9 yrs (range 0-24); BMI SDS 0.61 +0.97; mean aggregated HbA1c from all visits in the 5-yr period was 8.7+1.8% (71.9+19 mmol/L); only 530 (11%) achieved an aggregated HbA1c< 7.0% (53mmol/mol). At their last visit, mean HbA1c was 8.8 +1.9% (72.6+20.7 mmol/L); 569 (13%) had HbA1c< 7.0%; 54% (n=2,231) used multiple-daily injections (MDI), 39% (n=1,606) CSII and 8% (n=335) twice-daily (BD) injections. HbA1c was slightly higher in females vs males (8.9 vs 8.7%, 73.3 vs 71.9mmol/mol, p=0.02) and in those diagnosed < age 10 yrs vs >10 yrs (8.9 vs 8.7%, 73.3 vs 71.9mmol/mol, p< 0.001). In multivariable linear regression, higher HbA1c was associated with younger age at T1D diagnosis (p< 0.001), female gender (p=0.03) and BD therapy vs MDI/CSII (p< 0.001). Conclusion(s): The glycemic control of adolescents and young adults with T1D across Australasia is persistently sub-optimal across this age range, particularly among those with young onset of T1D. There is a need to better understand factors that contribute to these observations, and how healthcare services can support achievement of improved glycemic control in this population.