National trends in hyperglycaemia and diabetic ketoacidosis in children, adolescents and young adults with type 1 diabetes. A challenge due to age, stage of development or is new thinking of service provision needed?
Adolescence is associated with high risk hyperglycaemia. This study examines the phenomenon in a life-course context.
Research design and methods
93,125 people with type 1 diabetes aged 5-30 years were identified from the National Diabetes Audit (NDA) and/or the National Paediatric Diabetes Audit (NPDA) for England and Wales for 2017/18-2019/20. For each audit year the latest HbA1c and hospital admissions for diabetic ketoacidosis (DKA) were identified. Data were analysed in sequential cohorts by year of age.
In childhood, unreported HbA1c measurement was uncommon but by 19 years had increased to 22.3% for males and 17.3% for females, reducing to 17.9% and 13.1% respectively by 30 years. Median HbA1c at 9 years was 7.6% (60mmol/mol) (IQR 7.1%-8.4%, 54-68mmol/mol) in males and 7.7% (61mmol/mol) (8.0%-8.4%, 64-68mmol/mol) in females increasing to 8.7% (72mmol/mol) (7.5%-10.3%, 59-89mmol/mol) and 8.9% (74mmol/mol) (7.7%-10.6%, 61-92mmol/mol) respectively at 19 years before falling to 8.4% (68mmol/mol) (7.4%-9.7%, 57-83mmol/mol) and 8.2% (66mmol/mol) (7.3%-9.7%, 56-82mmol/mol) respectively at 30 years. Annual hospitalisation for DKA rose steadily from 6 years (2.0% for males, 1.4% for females) to peak at 19 years for males (7.9%) and 18 years for females (12.7%) reducing to 4.3% for males and 5.4% for females at 30 years. At all ages over 9 years the prevalence of DKA was higher in females.
HbA1c and the prevalence of DKA increase through adolescence and then decline. Measurement of HbA1c, a marker of clinical review, falls abruptly in the late teenage years. Age-appropriate services are needed to overcome these issues.