Trajectories in HbA1c and other risk factors among adults with type 1 diabetes by age at onset
Introduction In type 1 diabetes, potential loss of life-years is greatest in those who are youngest at the time of onset. Using data from a nationwide cohort of patients with type 1 diabetes, we aimed to study risk factor trajectories by age at diagnosis.Research design and methods We stratified 30 ...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2021-08-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/9/1/e002187.full |
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| author | Naveed Sattar Marcus Lind Stefan Franzén Ann-Marie Svensson Araz Rawshani Jon Edqvist Aidin Rawshani |
| author_facet | Naveed Sattar Marcus Lind Stefan Franzén Ann-Marie Svensson Araz Rawshani Jon Edqvist Aidin Rawshani |
| author_sort | Naveed Sattar |
| collection | DOAJ |
| description | Introduction In type 1 diabetes, potential loss of life-years is greatest in those who are youngest at the time of onset. Using data from a nationwide cohort of patients with type 1 diabetes, we aimed to study risk factor trajectories by age at diagnosis.Research design and methods We stratified 30 005 patients with type 1 diabetes aged 18–75 years into categories based on age at onset: 0–10, 11–15, 16–20, 21–25, and 26–30 years. HbA1c, albuminuria, estimated glomerular filtration rate (eGFR), body mass index (BMI), low-denisty lipoprotein (LDL)-cholesterol, systolic blood pressure (SBP), and diastolic blood pressure trends were analyzed using mixed models. Variable importance for baseline HbA1c was analyzed using conditional random forest and gradient boosting machine approaches.Results Individuals aged ≥16 years at onset displayed a relatively low mean HbA1c level (~55–57 mmol/mol) that gradually increased. In contrast, individuals diagnosed at ≤15 years old entered adulthood with a mean HbA1c of approximately 70 mmol/mol. For all groups, HbA1c levels stabilized at a mean of approximately 65 mmol/mol by about 40 years old. In patients who were young at the time of onset, albuminuria appeared at an earlier age, suggesting a more rapid decrease in eGFR, while there were no distinct differences in BMI, SBP, and LDL-cholesterol trajectories between groups. Low education, higher age, and poor risk factor control were associated with higher HbA1c levels.Conclusions Young age at the diabetes onset plays a substantial role in subsequent glycemic control and the presence of albuminuria, where patients with early onset may accrue a substantial glycemic load during this period. |
| first_indexed | 2024-12-17T12:16:07Z |
| format | Article |
| id | doaj.art-653bd5908adb4e118c84ed09f1bdf451 |
| institution | Directory Open Access Journal |
| issn | 2052-4897 |
| language | English |
| last_indexed | 2024-12-17T12:16:07Z |
| publishDate | 2021-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Diabetes Research & Care |
| spelling | doaj.art-653bd5908adb4e118c84ed09f1bdf4512022-12-21T21:49:10ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972021-08-019110.1136/bmjdrc-2021-002187Trajectories in HbA1c and other risk factors among adults with type 1 diabetes by age at onsetNaveed Sattar0Marcus Lind1Stefan Franzén2Ann-Marie Svensson3Araz Rawshani4Jon Edqvist5Aidin Rawshani6BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UKDepartment of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden3 National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden 1 Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenDepartment of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Västra Götaland, SwedenDepartment of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Västra Götaland, SwedenIntroduction In type 1 diabetes, potential loss of life-years is greatest in those who are youngest at the time of onset. Using data from a nationwide cohort of patients with type 1 diabetes, we aimed to study risk factor trajectories by age at diagnosis.Research design and methods We stratified 30 005 patients with type 1 diabetes aged 18–75 years into categories based on age at onset: 0–10, 11–15, 16–20, 21–25, and 26–30 years. HbA1c, albuminuria, estimated glomerular filtration rate (eGFR), body mass index (BMI), low-denisty lipoprotein (LDL)-cholesterol, systolic blood pressure (SBP), and diastolic blood pressure trends were analyzed using mixed models. Variable importance for baseline HbA1c was analyzed using conditional random forest and gradient boosting machine approaches.Results Individuals aged ≥16 years at onset displayed a relatively low mean HbA1c level (~55–57 mmol/mol) that gradually increased. In contrast, individuals diagnosed at ≤15 years old entered adulthood with a mean HbA1c of approximately 70 mmol/mol. For all groups, HbA1c levels stabilized at a mean of approximately 65 mmol/mol by about 40 years old. In patients who were young at the time of onset, albuminuria appeared at an earlier age, suggesting a more rapid decrease in eGFR, while there were no distinct differences in BMI, SBP, and LDL-cholesterol trajectories between groups. Low education, higher age, and poor risk factor control were associated with higher HbA1c levels.Conclusions Young age at the diabetes onset plays a substantial role in subsequent glycemic control and the presence of albuminuria, where patients with early onset may accrue a substantial glycemic load during this period.https://drc.bmj.com/content/9/1/e002187.full |
| spellingShingle | Naveed Sattar Marcus Lind Stefan Franzén Ann-Marie Svensson Araz Rawshani Jon Edqvist Aidin Rawshani Trajectories in HbA1c and other risk factors among adults with type 1 diabetes by age at onset BMJ Open Diabetes Research & Care |
| title | Trajectories in HbA1c and other risk factors among adults with type 1 diabetes by age at onset |
| title_full | Trajectories in HbA1c and other risk factors among adults with type 1 diabetes by age at onset |
| title_fullStr | Trajectories in HbA1c and other risk factors among adults with type 1 diabetes by age at onset |
| title_full_unstemmed | Trajectories in HbA1c and other risk factors among adults with type 1 diabetes by age at onset |
| title_short | Trajectories in HbA1c and other risk factors among adults with type 1 diabetes by age at onset |
| title_sort | trajectories in hba1c and other risk factors among adults with type 1 diabetes by age at onset |
| url | https://drc.bmj.com/content/9/1/e002187.full |
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