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- Anderzén, Johan
(författare)
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Differences in glycemic control in type 1 diabetes children and adolescents : in a national and international perspective and the effect on microvascular complications in young adults
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis focuses on glycemic control measured as HbA1c in type 1 diabetes (T1D) patients during childhood and especially during adolescence, both in a Swedish and an international context, and relates the glycemic control to the risk of complications in young adults. In studies I and II, the Swedish Pediatric Diabetes Quality Register (SWEDIABKIDS) and the Swedish National Diabetes Register (NDR) were used. More than 4000 young adults with T1D and data on HbA1c in NDR both in 2011 and 2012 as well as data on HbA1c in SWEDIABKIDS were used. The T1D patients with poor glycemic control during their teenage period had a risk for retinopathy several times higher than those with good glycemic control. The risk for micro- and macroalbuminuria was also higher in those with poor glycemic control and was most pronounced in the T1D patients with high HbA1c in both registers. Females had worse glycemic control than males during the teenage period and an increased risk of retinopathy as young adults. In studies III and IV, pediatric diabetes quality register data from, respectively, eight and seven Western high-income countries were collected in the year 2013. Data on about 60 000 T1D patients were analyzed according to mean HbA1c levels in the countries and related to actual age and T1D duration to determine if there were differences in glycemic control between the countries. There were large differences in mean HbA1c between the countries, both when related to age and T1D duration. Despite the differences in mean HbA1c, the increase in mean HbA1c with increasing age and T1D duration was very similar in all countries. The overall picture of these studies is that good glycemic control is very important to avoid complications of T1D as young adults, and it seems particularly important to maintain a good glycemic control during adolescence. Furthermore large differences in glycemic control in T1D patients in Western high-income countries were found. Despite the differences in glycemic control, the pattern of rising HbA1c with increasing age and duration of T1D was very similar in all countries. Females have worse glycemic control than males during their teenage period, both in Sweden and internationally, and they also have more retinopathy as young adults. This thesis shows that it is of the utmost importance to treat T1D patients intensively directly after diagnosis, to treat the young T1D patients intensely and to reduce the rise in HbA1c with increasing age and duration of T1D in order to avoid complications early in life. Diabetes quality registers give the opportunity to compare results and share experiences, both within and between countries, so treatment of T1D can be designed in the best possible way and thereby minimize T1D complications.
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| 2. |
- Anderzen, J., et al.
(författare)
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International benchmarking in type 1 diabetes: Large difference in childhood HbA1c between eight high-income countries but similar rise during adolescence-A quality registry study
- 2020
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Ingår i: Pediatric Diabetes. - : Hindawi Limited. - 1399-543X .- 1399-5448. ; 21:4, s. 621-627
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To identify differences and similarities in HbA1c levels and patterns regarding age and gender in eight high-income countries. Subjects 66 071 children and adolescents below18 years of age with type 1 diabetes for at least 3 months and at least one HbA1c measurement during the study period. Methods Pediatric Diabetes Quality Registry data from Austria, Denmark, England, Germany, Norway, Sweden, the United States, and Wales were collected between 2013 and 2014. HbA1c, gender, age, and duration were used in the analysis. Results Distribution of gender and age groups was similar in the eight participating countries. The mean HbA1c varied from 60 to 73 mmol/mol (7.6%-8.8%) between the countries. The increase in HbA1c between the youngest (0-9 years) to the oldest (15-17 years) age group was close to 8 mmol/mol (0.7%) in all countries (P < .001). Females had a 1 mmol/mol (0.1%) higher mean HbA1c than boys (P < .001) in seven out of eight countries. Conclusions In spite of large differences in the mean HbA1c between countries, a remarkable similarity in the increase of HbA1c from childhood to adolescence was found.
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| 3. |
- Samuelsson, John, 1981-
(författare)
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Metabolic Control, Morbidity and Mortality in Type 1 Diabetes with Onset in Childhood/Adolescence
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis was to study mortality in individuals with onset of type 1 diabetes (T1D) in childhood and adolescence in Sweden, related to clinical characteristics such as metabolic control in childhood/adolescence and comorbidity. Methods: All studies in this thesis were register-based observational studies using a nationwide and population-based quality register, the paediatric part of the Swe-dish National Diabetes Register (NDR), for identification and collection of clinical data of individuals with T1D diagnosed before 18 years of age. Study I included 8084 individuals between 2000 and 2014, and compared these during follow-up based on HbA1c at onset of T1D. In studies II and IV 16,537 individuals with T1D registered from 2000 to 2014 were identified. This population was merged with the Swedish Cause of Death register (CDR) to identify deceased individuals during the study period and retrieve causes of death. In study II, the study period was set between 2006 and 2014, including 12,652 individuals. Standardised mortality rates (SMRs) were calculated using data from the Swedish population register. Study III included 15,188 individuals with onset of T1D between 2000 and 2019. Five randomly selected control individuals from the Swedish population were matched to each individual with T1D. These cohorts were linked to the National Patient Register to retrieve ICD codes on autoimmune diseases (AIDs), and to the CDR to identify deceased individuals. Medical records were retrieved from treating clinics for all de-ceased individuals in study IV. Results: Individuals in the highest quintile of HbA1c at onset of T1D (>114 mmol/mol) had higher HbA1c during follow-up compared to the lowest quintile (<72 mmol/mol) at onset, but there was no significant correlation between individual HbA1c at onset and during follow-up. In study II, 68 individuals were identified as deceased, of which almost 40% died due to diabetes, mainly caused by acute complications. The overall SMR was 2.7 per 1000 person-year. Those who died due to diabetes had significantly elevated HbA1c in childhood compared to those who died from other causes or were still alive. In study III, almost 20% of individuals with T1D developed at least one other AID. Coeliac disease was the most common followed by thyroid disease. Individuals with an additional AID did not have worse outcome in terms of metabolic control or mortality risk. In study IV, after review, 72 individuals had information in the medical records which was possible to evaluate regarding cause of death. Hypoglycaemia was the cause of death in two individuals (2.8%) and ketoacidosis in eight individuals (11.1%). In 16 (22.2%) individuals with cause of death due to diabetes with coma, no conclusion on whether death was caused by hypoglycaemia or ketoacidosis could be drawn. HbA1c was significantly elevated both in childhood and in the last year before death in medical records in those deceased due to diabetes. Conclusions: High HbA1c at onset of T1D cannot be used as a predictor of future metabolic control in the individual child or adolescent. Children and adolescents with high HbA1c in childhood have an increased risk of premature mortality, mainly due to acute complications of T1D. Hypoglycaemia was uncommon as a cause of death, contributing for certain to only 2.8 % of the mortality. Individuals with T1D have a high risk of developing other AIDs from the onset of diabetes; however such comorbidity was not associated with worse outcome in terms of metabolic control or mortality risk.
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