Effect of early glycemic control on HbA1c tracking and development of vascular complications after 5 years of childhood onset type 1 diabetes: Systematic review and meta-analysis.
Viner, Russell M
Stephenson, Terence J
Blackwell Publishing Inc.
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Mazarello Paes, V., Barrett, J., Taylor-Robinson, D. C., Chesters, H., Charalampopoulos, D., Dunger, D., Viner, R. M., & et al. (2019). Effect of early glycemic control on HbA1c tracking and development of vascular complications after 5 years of childhood onset type 1 diabetes: Systematic review and meta-analysis.. Pediatric diabetes, 20 (5), 494-509. https://doi.org/10.1111/pedi.12850
OBJECTIVE: A systematic review and meta-analysis was conducted to investigate if glycaemic control measured by glycated Haemoglobin (HbA1c) levels near diagnosis are predictive of future glycaemic outcomes and vascular complications in childhood onset type 1 diabetes (T1D). METHODS: Evidence was gathered using electronic databases (MEDLINE, EMBASE, Web of Science, CINAHL, Scopus and Cochrane Library up to February 2017) and snowballing techniques. Studies investigating the association between the exposure "early glycaemic control" and main outcome: "tracking of early control" and secondary outcome: risk of future complications; in children and young people aged 0 to 19 years at baseline; were systematically double-reviewed, quality assessed and outcome data extracted for synthesis and meta-analysis. FINDINGS: Five studies (N=4227 participants) were eligible. HbA1c levels were sub-optimal throughout the study period but tended to stabilise in a "track" by 6 months after T1D diagnosis. The group with low HbA1c <53mmol/mol (<7%) at baseline had lower long-term HbA1c levels than the higher HbA1c group. The estimated standardised mean difference between the sub groups showed a reduction of HbA1c levels on average by 1.6% (range -0.95 to -2.28%) from baseline. Only one study investigated the association between early glycaemic control and development of vascular complications in childhood onset T1D. INTERPRETATIONS: Glycaemic control after the first few months of childhood onset T1D, remains stable but sub-optimal for a decade. The low and high HbA1c levels at baseline seem to "track" in their respective tracks during the 10-year follow-up however, the initial difference between groups narrows over time. This article is protected by copyright. All rights reserved.
Humans, Diabetic Angiopathies, Diabetes Mellitus, Type 1, Hypoglycemic Agents, Adolescent, Child, Glycated Hemoglobin A
British Heart Foundation (RG/13/13/30194)
British Heart Foundation (RG/18/13/33946)
External DOI: https://doi.org/10.1111/pedi.12850
This record's URL: https://www.repository.cam.ac.uk/handle/1810/291548
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