Decreasing trends in mean HbA1c are not associated with increasing rates of severe hypoglycemia in children: A longitudinal analysis of two contemporary population-based pediatric type 1 diabetes registries from Australia and Germany/Austria between 1995 and 2016

Aveni Haynes, Julia M. Hermann, Helen Clapin, Sabine E. Hofer, Beate Karges, Timothy W. Jones, Elizabeth A. Davis, Reinhard W. Holl

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Abstract

OBJECTIVE To investigate temporal trends in glycemic control and severe hypoglycemia rates for pediatric patients with type 1 diabetes from 1995 to 2016 by analyzing data from the longitudinal, prospective, population-based German/Austrian (Diabetes Patient History Documentation [DPV]) and Western Australian (Western Australian Children's Diabetes Database [WACDD]) diabetes registries. RESEARCH DESIGN AND METHODS Patients diagnosed with type 1 diabetes aged 1c and severe hypoglycemia (self-reported loss of consciousness/convulsion) rates were calculated per 100 patient-years. RESULTS Between 1995 and 2016, the annual mean HbA1c decreased from 8.3 to 7.8% in the DPV cohort and from 9.2 to 8.3% in the WACDD cohort. Over the same period, the severe hypoglycemia rate decreased by an annual average of 2% (relative risk 0.983 [95% CI 0.981, 0.986]) in the DPV cohort and 6% (relative risk 0.935 [95% CI 0.934, 0.937]) in the WACDD cohort. Concomitant decreasing trends in both HbA1c and severe hypoglycemia rates were observed in boys and girls, all age-groups, and injection therapy/pump regimen groups. CONCLUSIONS Over the past two decades, there have been concurrent improvements in HbA1c and decreasing severe hypoglycemia rates in two contemporary, longitudinal, population-based pediatric cohorts of type 1 diabetes. Translation of these data into clinical practice and patient education may reduce fear of hypoglycemia and enable better glycemic control.

Original languageEnglish
Pages (from-to)1630-1636
Number of pages7
JournalDiabetes Care
Volume42
Issue number9
DOIs
Publication statusPublished - 20 Sep 2019

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Austria
Type 1 Diabetes Mellitus
Hypoglycemia
Germany
Registries
Pediatrics
Population
Databases
Unconsciousness
Patient Education
Group Psychotherapy
Documentation
Fear
Seizures
Age Groups
Injections

Cite this

@article{7adde9e58e9e4eacab67f3e0d7a9862f,
title = "Decreasing trends in mean HbA1c are not associated with increasing rates of severe hypoglycemia in children: A longitudinal analysis of two contemporary population-based pediatric type 1 diabetes registries from Australia and Germany/Austria between 1995 and 2016",
abstract = "OBJECTIVE To investigate temporal trends in glycemic control and severe hypoglycemia rates for pediatric patients with type 1 diabetes from 1995 to 2016 by analyzing data from the longitudinal, prospective, population-based German/Austrian (Diabetes Patient History Documentation [DPV]) and Western Australian (Western Australian Children's Diabetes Database [WACDD]) diabetes registries. RESEARCH DESIGN AND METHODS Patients diagnosed with type 1 diabetes aged 1c and severe hypoglycemia (self-reported loss of consciousness/convulsion) rates were calculated per 100 patient-years. RESULTS Between 1995 and 2016, the annual mean HbA1c decreased from 8.3 to 7.8{\%} in the DPV cohort and from 9.2 to 8.3{\%} in the WACDD cohort. Over the same period, the severe hypoglycemia rate decreased by an annual average of 2{\%} (relative risk 0.983 [95{\%} CI 0.981, 0.986]) in the DPV cohort and 6{\%} (relative risk 0.935 [95{\%} CI 0.934, 0.937]) in the WACDD cohort. Concomitant decreasing trends in both HbA1c and severe hypoglycemia rates were observed in boys and girls, all age-groups, and injection therapy/pump regimen groups. CONCLUSIONS Over the past two decades, there have been concurrent improvements in HbA1c and decreasing severe hypoglycemia rates in two contemporary, longitudinal, population-based pediatric cohorts of type 1 diabetes. Translation of these data into clinical practice and patient education may reduce fear of hypoglycemia and enable better glycemic control.",
author = "Aveni Haynes and Hermann, {Julia M.} and Helen Clapin and Hofer, {Sabine E.} and Beate Karges and Jones, {Timothy W.} and Davis, {Elizabeth A.} and Holl, {Reinhard W.}",
year = "2019",
month = "9",
day = "20",
doi = "10.2337/dc18-2448",
language = "English",
volume = "42",
pages = "1630--1636",
journal = "Diabetes Care",
issn = "0149-5992",
publisher = "American Diabetes Association",
number = "9",

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TY - JOUR

T1 - Decreasing trends in mean HbA1c are not associated with increasing rates of severe hypoglycemia in children

T2 - A longitudinal analysis of two contemporary population-based pediatric type 1 diabetes registries from Australia and Germany/Austria between 1995 and 2016

AU - Haynes, Aveni

AU - Hermann, Julia M.

AU - Clapin, Helen

AU - Hofer, Sabine E.

AU - Karges, Beate

AU - Jones, Timothy W.

AU - Davis, Elizabeth A.

AU - Holl, Reinhard W.

PY - 2019/9/20

Y1 - 2019/9/20

N2 - OBJECTIVE To investigate temporal trends in glycemic control and severe hypoglycemia rates for pediatric patients with type 1 diabetes from 1995 to 2016 by analyzing data from the longitudinal, prospective, population-based German/Austrian (Diabetes Patient History Documentation [DPV]) and Western Australian (Western Australian Children's Diabetes Database [WACDD]) diabetes registries. RESEARCH DESIGN AND METHODS Patients diagnosed with type 1 diabetes aged 1c and severe hypoglycemia (self-reported loss of consciousness/convulsion) rates were calculated per 100 patient-years. RESULTS Between 1995 and 2016, the annual mean HbA1c decreased from 8.3 to 7.8% in the DPV cohort and from 9.2 to 8.3% in the WACDD cohort. Over the same period, the severe hypoglycemia rate decreased by an annual average of 2% (relative risk 0.983 [95% CI 0.981, 0.986]) in the DPV cohort and 6% (relative risk 0.935 [95% CI 0.934, 0.937]) in the WACDD cohort. Concomitant decreasing trends in both HbA1c and severe hypoglycemia rates were observed in boys and girls, all age-groups, and injection therapy/pump regimen groups. CONCLUSIONS Over the past two decades, there have been concurrent improvements in HbA1c and decreasing severe hypoglycemia rates in two contemporary, longitudinal, population-based pediatric cohorts of type 1 diabetes. Translation of these data into clinical practice and patient education may reduce fear of hypoglycemia and enable better glycemic control.

AB - OBJECTIVE To investigate temporal trends in glycemic control and severe hypoglycemia rates for pediatric patients with type 1 diabetes from 1995 to 2016 by analyzing data from the longitudinal, prospective, population-based German/Austrian (Diabetes Patient History Documentation [DPV]) and Western Australian (Western Australian Children's Diabetes Database [WACDD]) diabetes registries. RESEARCH DESIGN AND METHODS Patients diagnosed with type 1 diabetes aged 1c and severe hypoglycemia (self-reported loss of consciousness/convulsion) rates were calculated per 100 patient-years. RESULTS Between 1995 and 2016, the annual mean HbA1c decreased from 8.3 to 7.8% in the DPV cohort and from 9.2 to 8.3% in the WACDD cohort. Over the same period, the severe hypoglycemia rate decreased by an annual average of 2% (relative risk 0.983 [95% CI 0.981, 0.986]) in the DPV cohort and 6% (relative risk 0.935 [95% CI 0.934, 0.937]) in the WACDD cohort. Concomitant decreasing trends in both HbA1c and severe hypoglycemia rates were observed in boys and girls, all age-groups, and injection therapy/pump regimen groups. CONCLUSIONS Over the past two decades, there have been concurrent improvements in HbA1c and decreasing severe hypoglycemia rates in two contemporary, longitudinal, population-based pediatric cohorts of type 1 diabetes. Translation of these data into clinical practice and patient education may reduce fear of hypoglycemia and enable better glycemic control.

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U2 - 10.2337/dc18-2448

DO - 10.2337/dc18-2448

M3 - Article

VL - 42

SP - 1630

EP - 1636

JO - Diabetes Care

JF - Diabetes Care

SN - 0149-5992

IS - 9

ER -