International diabetes registries report that many young people with type 1 diabetes (T1D) do not meet their recommended targets for glycaemic control, however relevant Australian data has been lacking. The Australasian Diabetes Data Network (ADDN) funded by the Type 1 Diabetes Clinical Research Network (T1DCRN) and led by the Australasian Paediatric Endocrine Society (APEG) and Australian Diabetes Society (ADS) is a secure, centralised database that captures de-identified clinical data from thousands of people after diagnosis of T1D on a single purpose built database. The ADDN study group has published the first national surveillance of glycaemic control and management of type 1 diabetes in young people in Australia.
The results, published in Medical Journal of Australia, provides a snapshot of data stored within the ADDN from 5 large paediatric centres in Australia. One of the ADDN investigators Professor Maria Craig presented these results in August last year at the ADS national conference.
This cross sectional analysis included over 3200 children and adolescents (mean age 12.8 years) with T1D of at least 12 months duration (mean duration 5.7 years) for whom data were added to the ADDN registry during 2015.
This analysis found that the mean HbA1c level was 67mmol/mol, and only 27% of individuals met the target of less than 58mmol/mol. The mean HbA1c level was lower in children under 6 (63 mmol/mol) than in adolescents (14-18 years; 69 mmol/mol). Mean body mass index standard deviation scores (BMI-SDS) for all participants was 0.6 (SD, 0.9); 33% of the participants were overweight or obese.
44% were treated with CSII (continuous subcutaneous insulin infusion), 38% with MDI (multiple daily injections) and 18% with BD (twice-daily injections). When stratified by insulin regimen, there was little difference in mean HbA1c within age groups, but adolescents had highest HbA1c over all treatment types.
This data, while comparable to that reported in a number of overseas registries, highlights the urgent need to improve glycaemic control in young people and adolescents. Managing T1D in adolescents is particularly challenging for clinicians as parental involvement often declines at the time of metabolic changes occurring during puberty. While this snapshot did not include those over the age of 18, there is emerging evidence that the deterioration of glycaemic control during adolescence continues into early adulthood, and does not improve to recommended levels before age 30. This has implications for risk of complications. Additionally, the rates of overweight and obesity were higher in this sample compared to the general population. This is concerning as excess weight is an independent risk factor for complications of T1D.
This data identified from this snapshot is just the beginning of what insights we could gather from ADDN in the future. In 2016 the ADDN was awarded an extra $2.45M in funding, allowing expansion from the initial 5 paediatric centres to inclusion of more regional and remote centres, as well as transition and adult diabetes centres. With this large data capture, researchers will be able to gather long-term data on how T1D progresses over time and the effect of different treatments and therapies on patient outcomes.