Good Blood Glucose Control Shortens Diabetic Status Duration In Youth
Overview
The primary objective of this investigation was to assess the glycemic regulation status and discern the impacts of disease progression and comprehensive management strategies on blood glucose levels in juvenile and adolescent populations diagnosed with type 2 diabetes mellitus (T2DM).
Methodology involved the collection of clinical data pertaining to T2DM patients at Beijing Children’s Hospital between January 2015 and September 2020. Patients were categorized based on disease duration for comparative analysis of glycated hemoglobin (HbA1c) levels, islet β-cell function, insulin resistance, and the implementation of comprehensive management protocols.
Results indicated a median disease duration of 2.0 years (interquartile range [IQR] 1.0–4.0 years) among the 170 participants, with a baseline HbA1c of 11.2% (IQR 9.2–12.4%). Stratification by disease duration revealed varying HbA1c levels, with the shortest duration (<2 years) group exhibiting the lowest median HbA1c (5.7% [IQR 5.3–6.1%]), whereas the longest duration (>4 years) group displayed the highest median HbA1c (9.0 [IQR 6.8%–11.3%]). Furthermore, patients with a disease duration exceeding 4 years demonstrated a decreased proportion of HbA1c <7% (29.2% vs. 66.2%), diminished homeostasis model assessment of β-cell function, and a reduced adherence to dietary control, moderate-intensity exercise, regular monitoring, and pharmaceutical interventions.
Regression analysis identified disease duration, β-cell function at follow-up, consistent moderate-intensity exercise, regular clinical assessments, and treatment regimen as significant determinants influencing glycemic control.
Introduction
The rise in the prevalence of type 2 diabetes mellitus (T2DM) among children and adolescents is intricately linked with the advancements in socioeconomic status. This demographic shift presents a multifaceted challenge for healthcare professionals, as the treatment of T2DM in this age group is not only influenced by genetic and physiological factors but also by familial and societal dynamics. Furthermore, the burgeoning rates of T2DM in youth are exacerbated by profound lifestyle changes, including sedentary behaviors and unhealthy dietary patterns, which often lead to poor treatment compliance.
Unlike adult patients, children and adolescents diagnosed with T2DM typically experience an earlier onset of the disease and an extended lifespan post-diagnosis. This protracted disease trajectory underscores the urgent need for proactive and effective management measures aimed at averting or mitigating the onset of diabetic complications. Insightful studies, such as the SEARCH investigation conducted in the United States, have shed light on the progressive nature of T2DM, revealing a positive correlation between disease duration and glycemic control. Notably, dietary interventions, such as the avoidance of high-fat foods and vigilant carbohydrate monitoring, have been shown to exert a sustained impact on glycated hemoglobin (HbA1c) levels over prolonged periods.
However, while existing research has provided valuable insights into the dietary aspects of T2DM management in adolescents, there remains a dearth of comprehensive studies exploring the broader spectrum of management modalities, including physical activity interventions, treatment protocols, and self-monitoring of blood glucose (SMBG) practices, particularly within the context of the Chinese pediatric population.
The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) project, conducted in the United States, has underscored the pivotal role of lifestyle modifications, such as dietary adjustments and increased physical activity, in optimizing glycemic control among adolescent T2DM patients. Nonetheless, the scarcity of similar investigations within the Chinese pediatric cohort presents a critical gap in our understanding of effective management strategies tailored to this demographic.
In response to this gap, the present study, conducted at Beijing Children’s Hospital, aims to bridge this knowledge void by evaluating the efficacy of comprehensive management interventions on blood glucose regulation in children and adolescents with T2DM. By elucidating the impact of various management modalities on glycemic control, this research endeavor seeks to furnish high-level evidence-based insights that can inform and enhance the clinical care of pediatric T2DM patients, ultimately striving towards better outcomes and improved quality of life for this vulnerable population.
Methods
Inclusion Criteria
- Children under the age of 18 years.
- Newly diagnosed with type 2 diabetes mellitus (T2DM).
- Patients presenting with specific diagnostic parameters:
– Fasting blood glucose level ≥ 7.0 mmol/L.
– 2-hour oral glucose tolerance test plasma glucose level ≥ 11.1 mmol/L.
– Random blood glucose level ≥ 11.1 mmol/L (200 mg/dL).
– HbA1c level > 6.5%.
- Diagnosis of type 2 diabetes confirmed through:
– Evidence of insulin resistance.
– Delayed release peak of insulin and C-peptide.
– Presence of acanthosis nigricans.
– Family history of type 2 diabetes and obesity.
Exclusion Criteria
- Patients lost to follow-up.
- Patients lacking HbA1c level records from January 1 to October 1, 2020.
- Patients with corrected diagnosis of type 1 diabetes or juvenile-onset type 1 diabetes.
This study, conducted as part of the China National Key Research and Development Program, aimed to investigate the prevalence, nutritional aspects, and influencing factors of diabetes in children and adolescents (No. 2016-YFC1305301). Ethical approval was obtained under medical ethics approval number 2016-IRB-018, and informed consent was secured from patients’ guardians.
Methods employed in the study encompassed the collection of baseline data including demographic details and various parameters related to glucose metabolism. Follow-up procedures involved standardized measurements of physical parameters, assessment of dietary adherence, exercise habits, and treatment compliance. Laboratory examinations were conducted to evaluate glucose metabolism indexes, with assessments of insulin resistance and β-cell function utilizing established models. Diagnostic criteria for complications such as retinopathy and peripheral neuropathy were based on specialized assessments by ophthalmologists and neurologists, adhering to recognized guidelines.
Management strategies for diabetes included standardized education upon admission, with individualized counseling provided during outpatient visits. Dietary recommendations were based on established guidelines, with specific caloric intake targets and exercise intensity prescribed to promote glycemic control. Regular follow-up visits were scheduled as per consensus guidelines to monitor patient progress and adjust treatment plans accordingly, ensuring optimal management of pediatric T2DM.
Statistical Analysis
For data analysis, we utilized SAS 9.4 software from SAS Institute, Cary, NC, USA. Measurements following a normal distribution, such as age at baseline and waist circumference at baseline, were expressed as mean values with standard deviations. Group comparisons were conducted using analysis of variance (ANOVA). Conversely, non-normally distributed data, including HOMA-IR, HOMA-b, BMI at baseline, disease duration, and HbA1c levels, were presented as medians with interquartile ranges (IQR). Group comparisons for these variables were assessed using the Wilcoxon rank-sum test. Count data, such as occurrences of acanthosis nigricans, normal body shape, overweight, obesity, presence of diabetes ketosis or diabetic ketoacidosis at disease onset, rate of achieving standard HbA1c levels, and adherence to diabetes management measures, were presented as numbers and percentages. Group comparisons for count data were evaluated using the chi-square test.
To identify factors influencing blood glucose levels, univariate analysis was initially conducted to screen potential influencing variables. Independent variables considered included HbA1c levels, disease duration, age at baseline, BMI at baseline, HOMA-b at follow-up, adherence to dietary control, engagement in moderate-intensity exercise, regular medical review, and treatment regimen. Significant independent variables identified from the univariate analysis were then included in a generalized linear regression model.
A p-value less than 0.05 was considered indicative of a statistically significant difference. This rigorous statistical approach enabled us to discern meaningful associations and determinants of blood glucose regulation in our study cohort, facilitating comprehensive insights into the management of pediatric type 2 diabetes mellitus.
Results
In this study, 170 pediatric patients diagnosed with type 2 diabetes were included, comprising 105 boys and 65 girls, with a mean age of 12.2 ± 2.1 years. The median disease duration was 2.0 years (interquartile range [IQR] 1.0–4.0 years), with a median HbA1c level of 11.2% (IQR 9.2–12.4%). Key metabolic parameters such as HOMA-IR and HOMA-b were evaluated, with respective median values of 4.0 (IQR 2.6–5.9) and 100.8 (IQR 56.81–67.5). Additionally, anthropometric measurements revealed a median waist circumference of 89.6 ± 11.3 cm and a median BMI of 24.6 kg/m2 (IQR 22.7–28.2 kg/m2). Notably, 69.4% of patients presented with acanthosis nigricans, while 7.6% had normal BMI, 20.0% were overweight, and 72.4% were classified as obese. Half of the patients (50.0%) experienced complications such as diabetes ketosis or diabetic ketoacidosis at disease onset.
Glycemic control was stratified based on disease duration, revealing an inverse relationship between disease course and median HbA1c levels. Patients were categorized into three groups based on disease duration (<2 years, 2–4 years, and ≥4 years), with a significant decline in the proportion of patients achieving good glycemic control as disease duration increased. Moreover, analysis of insulin resistance and islet β-cell function demonstrated a decline in HOMA-b values with longer disease duration, accompanied by elevated HbA1c levels. Notably, patients with longer disease duration exhibited poorer adherence to dietary control, exercise regimens, and medication intake.
Univariate analysis identified several significant variables influencing blood glucose levels, including disease duration, age at baseline, BMI stratification, HOMA-b at follow-up, dietary control, moderate-intensity exercise, and regular treatment review. Subsequent generalized linear regression analysis revealed HOMA-b at follow-up, continuous moderate-intensity exercise, and regular treatment review as independent factors significantly impacting glycemic control.
This study underscores the complex interplay between disease duration, metabolic parameters, and adherence to management measures in pediatric type 2 diabetes. It highlights the importance of early intervention and comprehensive management strategies to optimize glycemic control and mitigate long-term complications in this vulnerable population.
Conclusion
In this real-world study focusing on Chinese pediatric and adolescent patients with type 2 diabetes, the investigation delved into the effects of glycemic control and comprehensive diabetes management. Findings revealed that an extended duration of type 2 diabetes may lead to a more rapid decline in islet β-cell function, diminished adherence to comprehensive management protocols, and an increased likelihood of suboptimal glycemic control among pediatric and adolescent populations. By shedding light on these dynamics, the study contributes vital evidence-based insights into blood glucose regulation in this specific demographic.
Existing research has highlighted various factors influencing blood glucose levels, including disease duration, age, gender, lifestyle modifications, and family history of diabetes. However, limited evidence exists regarding the evolving trajectory of blood glucose levels over the course of diabetes, particularly in children and adolescents with type 2 diabetes. This study addresses this gap by elucidating the impact of disease duration on glycemic control.
Results from the study underscore the significant influence of disease duration on glycemic status. Notably, the one-year mark emerged as a critical juncture, marking the onset of deteriorating blood glucose levels. Subsequently, the risk of poor glycemic control escalated annually, aligning with prior research findings.
By elucidating the nuanced relationship between disease duration and glycemic control in pediatric and adolescent patients with type 2 diabetes, this study provides valuable insights for clinicians and healthcare practitioners. Such insights inform the development of targeted interventions and personalized management strategies aimed at optimizing blood glucose control and enhancing long-term health outcomes in this vulnerable population.
Oncology Related Tools
Other
Latest Research
