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29-10-2019 | Diabetes | News | Article

Adult-onset type 1 diabetes may benefit from more intense monitoring in the early days

medwireNews: Research suggests that individuals with adult-onset type 1 diabetes could benefit from more intense monitoring, as only a minority meet recommended targets for glycemic control despite initial improvements, while at the same time the majority become overweight or obese.

Shenaz Ramtoola (Royal Blackburn Hospital, UK) and colleagues believe that paying “greater attention to achieving recommended glycaemic targets, weight management and preventing new and/or treating existing comorbid conditions, is warranted.”

They add: “Such efforts may be especially important in the first 12 months after diagnosis.”

Ramtoola and team analyzed retrospective, longitudinal data from the UK Clinical Practice Research Datalink for 2430 UK adults (mean age 41 years, 63% men) who were diagnosed with type 1 diabetes between 1990 and 2013.

They report in Primary Care Diabetes that mean glycated hemoglobin (HbA1c) levels in the cohort decreased significantly from 10.8% (95 mmol/mol) at baseline to 7.7% (61 mmol/mol) at 1 year, then remained stable through to year 5, with no further improvement from baseline.

However, only 6.3% of patients had an HbA1c below 6.5% (48 mmol/mol) at 1 year.

In addition, mean BMI increased significantly from 25.3 kg/m2 at baseline to 27.2 kg/m2 at 1 year, and remained significantly higher for the duration of the study, with over two-thirds (69%) of participants being overweight or obese by year 5, which corresponded to an increase of 23 percentage points from baseline, and was 8 percentage points higher than the level of overweight and obesity reported in the general UK population.

Charlson comorbidity index (CCI) score also increased significantly with time, from 1.32 at baseline to 1.46, 1.58, 1.62, and 1.75 at years 1, 2, 3, and 5, respectively.

And the researchers note that the increase in CCI was apparent regardless of BMI or HbA1c strata.

With regards to specific comorbidities, the team found that the greatest increase in prevalence from year 1 to year 5 was for diabetes with complications, by 411%, followed by renal disease (356%), peripheral vascular disease (176%), cerebrovascular disease (172%), and cancer (144%).

Ramtoola et al also observed similar changes in each of the outcome measures they assessed when they analyzed the data in 7-year time periods to reflect changes in treatment guidelines.

The authors conclude that their findings are “in broad agreement with the UK National Diabetes Audit findings of suboptimal glycaemic control in patients with [type 1 diabetes].”

They add: “Our data indicate that the comorbidities driving changes in the CCI over the first 5 years are not the cardiovascular diseases that are known to drive mortality in diabetes, but those stemming from diabetes-related complications and renal disease.

“This could be due to cardiovascular disease effects taking more than 5 years to evolve, or the fact that the other diabetes-related conditions were already more clinically advanced in these patients.”

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Prim Care Diabetes 2019; doi:10.1016/j.pcd.2019.09.009