Recent study shows- most youth do not meet A1C goals

Interesting article I came across. Youth do meet BP, lipid and BMI targets



FRIDAY, Feb. 8 (HealthDay News) -- Most children with type 1 diabetes (T1D) have hemoglobin A1c (HbA1c) values above target levels, according to a study published online Jan. 22 in Diabetes Care.

Jamie R. Wood, M.D., from the Children's Hospital Los Angeles, and colleagues assessed the proportion of youth meeting targets for HbA1c, blood pressure, and body mass index (BMI) using data from 13,316 participants in the T1D Exchange Clinic Registry younger than 20 years old with type 1 diabetes for at least one year.

The researchers found that 64, 43, and 21 percent of participants met the American Diabetes Association HbA1c targets of <8.5 percent for those younger than 6 years, <8.0 percent for those age 6 to younger than 13 years old, and <7.5 percent for those age 13 to younger than 20 years old, respectively. Most participants met the blood pressure and lipid targets, and two-thirds met the goal of <85th percentile for BMI.

"Despite advances in technologies and strategies for care, achieving HbA1c targets remains a significant challenge for the majority of youth in the T1D Exchange registry. Moreover, a large number of youth with diabetes already have additional vascular disease risk factors at a young age," the authors write. "This analysis suggests further transformations to improve pediatric diabetes care are needed to prevent future complications of diabetes."

One author disclosed receiving consultant payments from Medtronic.



http://www.physiciansbriefing.com/Article.asp?AID=672992

 

Interesting. I wonder how long this study was run for? Was it an equal balance of participants based on age? LOL, I'm not about to pay to subscribe so that I can read this article
All I can say is at this point in our lives, we've always fit into the expected parameters for age range.

 

Interesting but it just leads to more questions, doesn't it? Are children not getting the level of care they should? Or are the expectations unrealistic?

My dd meets her A1C goal (lately at least) but not her BMI.

 

Agreed, I had more questions.
You say your daughter doesn't meet BMI. That got me thinking, because my friend and I were just discussing this. Her son, about every 3 or 4 months has a growth spurt. So he won't be in his BMI range. Then, the next 3 or 4 months he's shot up and meets BMI. So, here's my question. Did the study only look at each subject once, or did they follow them for an entire year of visits?

 

It would be great to see the full study. There was 13000 participants which is a great sample size. Some longitudinal data would be great. I would like to see how kids are meeting targets in childhood and thn how they do a young adults on up.

I was wondering if there is a diabetic registry that they monitor kids starting at the time of diagnosis and collect data yearly or more to see how they do over the years.

 

That seems crazy that people have that much trouble getting under those fairly high (IMO) A1c ranges. We are not the MOST anal retentive about Molly's D care, I mean, we check, we correct, but we ball park carbs A LOT and then come back a couple hours later and manage from there if she's higher or lower than expected, but we do not have trouble keeping her a1c under 7 at 6 years old. She is out of her honeymoon as well. There was a bit of a learning curve as she came out of it, but we adjusted and dealt fine.

I wonder if it's because a comparatively low number of cwd are using insulin pumps? I know it was harder to control DD's before we were pumping. I think the community here probably has an overall higher level of pumpers than the population at large.

Just some musings.

 

cause it gets harder

I look back on the first five years or so years and think how much easier it was when my dd was 1. younger and I controlled pretty much everything, 2. her pancreas was obviously still helping even though she wasn't in "honeymoon" and 3. the hormones weren't all in a rage.

 

As a long time T1 I have to say that not all T1s are the same.:cwds: Some of us have a pancreas that helps out for many years, some of us it does zilch from day one. Some of us have a digestive system that is the same every day and predictable, some of us not. Some of us have predictable sex hormone impacts once puberty sets in through age 60 some of us not. Some of us do not react much to variations in exercise some of us have huge variations just from a walk around the block. Some of us react to all insulins about the same others of us have bodies that love some insulins and hate others. Count your blessings if you are able to manage without tons of work, it sometimes is because the parent or individual is not working at it much but sometimes it is just harder for some people.ali

 

wish i could view the entire article without having to pay for it. We're lucky that Ashleigh's A1C has met the ADA guidelines of less than 7.5% since dx. Her last A1C in January was 5.7%

 

Agreed.
With age comes more responsibility so they have more freedom, but that also means more "oops." "Oops, I forgot to check, oops I forgot to bolus..." Combined with hormones, her A1c fluctuates...you can definitely see a difference between summer when I am more in charge and during the school year where she's in charge.

Bottom line though, she's got a fairly respectable A1c, she's happy and most important, healthy.

 

With my DD, we test 10-12 times a day, check at night, get up at 5:30 in the morning to do a correction to help breakfast, prebolus every meal and snack - sometimes by 30-40 minutes, weigh everything, pay attention to glycemic index, review numbers for patterns daily and upload everything once a week to monitor changes we make and are so over-the-top compared to every other IRL diabetic family we know...and DD only dropped below 8 within the past year. AFTER we came off the pump. We work our asses off to get her in the 7s...but we worked just as hard to get in the 8s for years. And we haven't been in the recommended range every visit. It's hard. As you guys all know.

DS, on the other hand, is in this amazing thing called a honeymoon. He wakes up around 100 every day, rarely strays over 200, has a meter average of 117 this month. He tests 7 times a day and it's usually because of meals, snacks or a school activity. He takes 1/20 of the work that DD takes, uses 1/6 of the insulin she uses and his a1c will be fabulous. The doc says this could last for years, which means he could easily be in target a1c ranges with minimal effort for quite awhile.

Same parenting. Same diseases. Same family. Totally different body styles, metabolisms, digestions and responses to food and insulin. Effort does not always equal results.

 

Yes, I definitely do not have hormones to deal with, and I know that complicates things much more. I'm just talking about the day to day with a kiddo my daughter's age. She has some craziness sometimes, but overall she's at least fairly predictable.

 

Seth has missed that goal 4 times. Every time he has been in the mid 8's during football season. Adrenaline from tackling people then worrying about lows is very hard. :/

 

Bingo! The teen years are quite challenging. Puberty/hormones, wanting to eat all the time, wanting to just be "normal"..... it's quite different than dealing with a little one. My son was so open about his D when he was first dx'd at the age of almost 8. Fast forward to 14 and he's the exact opposite. While he does test at school, I'm finding he's doing it less and less. Which we need to work on. But I'm choosing my battles and right now all is good.

 

For sure, I think Seth eats every three hours. He is still open, but he went through a phase of testing then just winging the amount of insulin. He fessed up, I thanked him for telling the truth, and he's been doing much better. :cwds:

 

I think most of us by virtue of the fact that we are here are pretty diligent about D care. Lots of people aren't. But even for those of us that are, there can be a lot of variation in a1Cs. Some kids just seem easier to manage than others. For us toddler years were hard. Things got a little better around age 7. They are also better off the pump than they were on. We haven't hit the dreaded teens yet. But even at our best the lowest we saw was 6.9 and that was pretty fleeting. I envy those of you regularly in the 6s or lower but I am just not sure that is possible for every kid, at least not without extreme lifestyle changes I am not willing to make.

But I still think we need to ask why about his study.some are no doubt not getting the care they should. For others maybe the goals are unrealistic(it seems like a trick to make the goal lower just when puberty kicks in). And what makes one easier to manage than another?

 

I am in the group that says A1c is a very personal thing that is affected by factors beyond how diligent someone is in their diabetes control.

Matt's A1c is always around 8 despite our best efforts. I test him at midnight and 3am every night. We test/correct all day and night. For Matt, I think the issue is his body's ability to handle exercise. If he doesn't have gym, his numbers are completely different than if he does. A simple gym period can send him crashing, even with a temp basal and a snack. It is so unpredictable. Sometimes he will get a crazy adrenaline high, and other times he will go from 150 to 50 in the blink of an eye. Other times it won't affect him at all. It is crazy.

With that said, we have to keep his target numbers higher than most people. I can't have Matt spending much time between 80 and 100 when exercise from earlier in the day often makes him drop inexplicably hours later. Even YOGA has had this affect.

I do admit, though, that Matt eats a lot and he tends to eat a lot of carbs. We were told to not hold back on food or carbs since he wasn't growing.

 

The goals may seem unrealistic that they become more difficult at the same time management becomes astronomically more difficult, but I believe the reason is that the thought complications tend to start showing up more in puberty and beyond, not at the earlier ages. I know adult endos want a 7 or below, preferably a 6 or below.

 

Re adult endos. I have never had one push for below 6. If you do it safely great
but it has never been suggested that below 6 is the goal. This is just my experience.:cwds:ali

 

What does yours ask of you? One T1 adult I know's endo wasn't happy with a 6.9, and the other adult T1's endo wants around a 6 or lower. I hope adulthood makes for easier management than puberty!!!