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Association between early glycemic management and diabetes complications in type 1 diabetes mellitus: A retrospective cohort study

  • Junghwan Suh
    Affiliations
    Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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  • Youngha Choi
    Affiliations
    Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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  • Jun Suk Oh
    Affiliations
    Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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  • Kyungchul Song
    Affiliations
    Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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  • Han Saem Choi
    Affiliations
    Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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  • Ahreum Kwon
    Affiliations
    Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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  • Hyun Wook Chae
    Affiliations
    Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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  • Ho-Seong Kim
    Correspondence
    Correspondence to: Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50–1 Yonsei-ro, Seodaemun-gu, Seoul 120–752, South Korea.
    Affiliations
    Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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Published:January 04, 2023DOI:https://doi.org/10.1016/j.pcd.2022.12.006

      Highlights

      • Good glycemic control in patients with diabetes is crucial to prevent diabetes complications.
      • HbA1c levels tend to reach a certain level and then plateau after diagnosis of type 1 diabetes.
      • Early HbA1c levels were closely associated with recent HbA1c levels and diabetes complications in type 1 diabetes patients.
      • Strict glucose control after diagnosis and reducing variability of HbA1c may prevent future diabetic complications.

      Abstract

      Aims

      To investigate the association between early HbA1c levels near diagnosis and future glycemic management, and analyzed risk factors of complications in people with T1DM.

      Methods

      This retrospective cohort study included 201 children and adolescents with T1DM. Patient data including sex, age at diagnosis, duration of disease, HbA1c levels, HbA1c variability during the follow-up period, and diabetes complications and comorbidities were collected.

      Results

      The mean follow-up period of patients was 16.4 years. HbA1c levels in all three examined time points after diagnosis (first year, second year, and first two years) were significantly associated with recent HbA1c level, and second-year HbA1c was most closely correlated with recent HbA1c level. Elevated second-year HbA1c was a risk factor of diabetic ketoacidosis (DKA) and retinopathy, and increased variability of HbA1c was significantly related to various microvascular complications. When HbA1c is stratified into quartiles, the subjects of each quartile trend to stay within that quartile over the follow-up period.

      Conclusions

      Early HbA1c levels were closely associated with recent HbA1c levels and diabetes complications in patients with T1DMs. Strict glucose management after diagnosis and reducing variability of HbA1c may prevent future diabetes complications and comorbidities.

      Keywords

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