Factors predicting glycaemic control in young persons with type 1 diabetes

The International Study of Pediatric and Adolescent Diabetes (ISPAD) guidelines state the glycaemic treatment goal for children with type 1 diabetes to be HbA1c <57mmol/mol (<7.5% DCCT standard) to minimise the risk of severe late complications. Teenagers with diabetes have a higher risk of psychiatric disorders and impaired quality of life (QoL) compared to healthy teenagers and the guidelines highlights the importance of regular measurement of health and QoL. Previous studies have shown a correlation between glycaemic control and QoL.

The aim of this study was to explore which health and QoL factors correlate and predict outcome in glycaemic control (HbA1c) in young persons with type 1 diabetes. A convenience sample of 204 patients with type 1 diabetes, 12–17 years of age, from three centres in Sweden were recruited. Respondents completed four questionnaires at a regular visit. Check your Health and DISABKIDS chronic generic module DCGM-37 measures physical and emotional health, social relations and QoL. The diabetes-specific module (DCGM-37-DM) measures how the persons are affected by diabetes. The Swe-DES -23 measures four different empowerment factors and The SDD attitudes towards diabetes. Medical data were collected from the patients' medical records. The results from the questionnaires were analysed by multiple linear regression analysis.

A total 22% reached the treatment goal of HbA1c <57mmol/mol, while 28% had poor glycaemic control with HbA1c >73 (>8% DCCT-standard). There was a strong positive correlation between age and HbA1c. Adolescents with poor glycaemic control reported lower physical and mental health, higher burden of diabetes, lower empowerment, more negative attitudes towards diabetes and they thought diabetes was more difficult to handle. Age, physical health, social relations, problem solving, goal achievement, and object evaluation (object=diabetes), predicted 25% of the total variation in HbA1c. Several health-related quality of life factors predict variation in glycaemic control. Our study emphasises the need for regular evaluation of QoL factors and an active discussion about these factors of life in regular care for young persons with type 1 diabetes.