Evolution and determinants of glycaemic control in children and adolescents with type 1 diabetes in Belgium : a 10-year period observational real-world study

Lysy, Philippe;Beckers, Dominique;Kristina Casteels;Daniel Klink;IQECAD Study Group (Initiative for Quality Improvement and Epidemiology in Children and Adolescents with Diabetes);et.al.
(2022) International Society for Pediatric and Adolescent Diabetes (ISPAD) — Location: Abu Dhabi (12.October.2022)

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Authors
  • Lysy, Philippe
    Author
  • Beckers, DominiqueUNamur
    Author
  • Kristina Casteels
    Author
  • Daniel Klink
    Author
  • Lysy, PhilippeUCLouvain
    Author
  • IQECAD Study Group (Initiative for Quality Improvement and Epidemiology in Children and Adolescents with Diabetes)
    Author
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Abstract
Introduction: Since 2008 all Belgian paediatric diabetes centres (PDCs) participate to a biennial audit/feedback, allowing to monitor the quality of care given in PDCs and to describe clinical and demographic characteristics of young patients with type 1 diabetes (T1D) on a national level. Objectives: Here we present the evolution of the hemoglobin A1c (HbA1c) between 2008 and 2019 and investigate the determinants of HbA1c among children and adolescents with T1D. Methods: Data were cross-sectionally and retrospectively collected between 2008 and 2019 from all Belgian PDCs (N=16). The evolution over time of HbA1c was investigated on a continuous scale with generalized estimating equations (GEE). The association of HbA1c with age, gender, diabetes duration, presence of nuclear family, parent ethnicity, presence of a communication problem with the medical team, and insulin regimen were studied using GEE and Tukey-Kramer tests, as was the presence of psycho-social distress in the 2019 dataset. Results: The number of patients with T1D (age 1-18 years) varied from 1,948 in 2008 to 3,777 in 2019. There was a linear decrease in HbA1c of 0.026±0.008 percentage points per year on average: from 63 mmol/mol (7.9%) in 2008 to 60 mmol/mol (7.7%) in 2019 (P< 0.0001, adjusted for gender, age and diabetes duration). In 2019, the oldest patients (aged between 16-18 years), patients with the highest diabetes duration (>8.25 years), not living in a nuclear family, with two parents of non-Caucasian ethnicity (versus having at least one parent of Caucasian ethnicity) or having psychosocial distress had higher HbA1c compared to the other groups (P< 0.0001, adjusted for gender, age and diabetes duration). The presence of a communication problem was also associated with higher HbA1c, although less pronounced (P< 0.05, adjusted for gender, age and diabetes duration). Conclusions: Our data shows that glycaemic control improved over the past 11 years, but several subgroups still have high HbA1c levels. These subgroups may have a higher risk for developing long-term complications and deserve particular attention.
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Lysy, P., Beckers, D., Kristina Casteels, Daniel Klink, Lysy, P., & IQECAD Study Group (Initiative for Quality Improvement and Epidemiology in Children and Adolescents with Diabetes). (2022). Evolution and determinants of glycaemic control in children and adolescents with type 1 diabetes in Belgium : a 10-year period observational real-world study. International Society for Pediatric and Adolescent Diabetes (ISPAD), Abu Dhabi. https://hdl.handle.net/2078.5/164699