Improved glycemic control in childhood diabetes: a 16-year study
Curt L. Rohlfing, Randie R. Little,
Hsiao-Mei Wiedmeyer, Jack D. England, Danita Rife, Karen
Derrick, Kate Kirchhoff, Debbie Suk, David E. Goldstein
University of Missouri, Columbia, MO, USA |
Curt L. Rohlfing
University of Missouri
Columbia, MO
USA |
 |
The results of the Diabetes Control and Complications
Trial (DCCT), published in 1993, showed that maintaining near-normal HbA1c
levels dramatically reduced risks for development and/or progression of
diabetic complications in adolescent and adult patients with Type 1
diabetes (ages 13–39) [1]. Based on these findings, the American
Diabetes Association (ADA) recommended a diabetes management goal of HbA1c
< 7.0% for patients with diabetes mellitus [2]. We examined HbA1c
results from pediatric patients with Type 1 diabetes seen at the
University of Missouri Health Sciences Center between 1983 and 1999 to
determine if there have been significant improvements in glycemic control,
and therefore outcome risks, in our patients. HbA1c was measured using a
highly precise HPLC system (CV < 3%). For each year, overall mean HbA1c
was calculated from individual patient means after exclusion of patients
³ 18 years of age and those with duration of diabetes less than one year.
Changes in mean age and mean duration were shown to have no significant
effect on change in mean percent HbA1c. Results showed that mean
HbA1clevels dropped only slightly between 1983 and 1993 (8.59% vs. 8.42%,
respectively), but thereafter fell steadily to a level of 7.93% in 1999
(Figure 3).
Most of this decline in HbA1c levels after 1993 occurred
in adolescents (Table V).
Moreover, between 1993 and 1999 the percentage of patients
with mean HbA1c < 7.0% (the ADA goal) rose from 15.7% to 22.6%, while
the percentage of patients with mean HbA1c > 8.0% (the ADA action
limit) fell from 41.5% to 36.1%. Our findings show a clinically
significant reduction in pediatric patient HbA1c levels since 1983, most
of which occurred after 1993, coinciding with the publication of the DCCT
results. These data suggest that using treatment goals based on the DCCT
may have improved outcome risks in our patients with Type 1 diabetes.
References
1 The Diabetes Control and Complications Group: The Effect
of Intensive Treatment of Diabetes on the Development and Progression of
Long Term Complications in Insulin-Dependent Diabetes Mellitus. Engl J Med
1993; 329: 977-986.
2 American Diabetes Association: Standards of Medical Care for Patients
with Diabetes Mellitus (Position Statement). Diabetes Care 1994;
17:616-623.
