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Title: Impact of early glycaemic control on later outcomes in childhood onset type 1 diabetes
Author: Mazarello Paes, Veena
ISNI:       0000 0004 7965 1243
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2019
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Background: Children and adolescents with type 1 diabetes (T1D) diagnosis find it challenging to maintain good glycaemic control (measured by HbA1c). Poor glycaemic control is associated with complications. Aims: To investigate: 1. The impact of early glycaemic control on long-term glycaemic outcomes in children and adolescents. 2. Predictors and trajectories of long-term HbA1c in childhood onset T1D. Methods: 1) Systematic review (SR) of evidence using six databases, Review Manager 5 and Stata 15. Results were summarized narratively and through algorithms, forest and harvest plots. 2) Analyses of longitudinal data of children and adolescents, followed for 10 years from T1D diagnosis, at three diabetes clinics in London, UK. Mixed effects, growth curve and percentile reference ranges models with fractional polynomials were used to analyse data in Stata 15 and R. Results: SR's conducted with a total of 4227 participants from developed countries showed HbA1c levels rose soon after T1D diagnosis and remained sub-optimally stable for a decade. Early HbA1c levels were sub-optimal and tracked during the 10-year follow-up. The predictors of poorer glycaemic control varied according to time after diagnosis and were older age, female sex, non-white ethnicity, single parent family, non-private health insurance, higher HbA1c levels at diagnosis, longer T1D duration, and non-intensive insulin regimen. Analyses of longitudinal data showed the 'remission' or 'honeymoon' period ended at < 3 months. HbA1c levels then settled into sub-optimal, long-term tracks. Three distinct, longitudinal classes of HbA1c trajectories were identified during the 10-year follow-up from diagnosis and class membership was associated with age at diagnosis, ethnicity and frequency of clinic visits. Percentile bands showing non-linear relationships with age and time were constructed. Risk factors for elevated HbA1c levels varied according to time from diagnosis and were : low pH (proxy for DKA), low BMI, insulin regimen, clinic site, year of diagnosis, higher HbA1c levels (at baseline and during 3-24 months after diagnosis) and non-white ethnicity.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available