Strict Glycemic Control Can Reduce Complications in Childhood-Onset Type 1 Diabetes Patients, Finds Study

A recent study published in the Diabetes/Metabolism Research and Reviews illuminated the significant impact of long-term blood sugar control on the development of diabetic complications in individuals with childhood-onset type 1 diabetes. This longitudinal cohort study of 3 decades evaluated the relationship between long-term weighted mean HbA1c (wHbA1c), HbA1c variability, diabetes duration, and lipid profiles in the context of diabetic peripheral neuropathy (DPN), nephropathy, and retinopathy.

The study followed a total of 49 patients (21 women) diagnosed with type 1 diabetes in childhood by examining them with neurophysiological tests, blood tests, and clinical examinations after an average diabetes duration of 7.7 years. These patients were then re-examined over an extended follow-up period averaging 30.6 years. This research calculated wHbA1c by integrating all HbA1c values recorded since diabetes diagnosis, while HbA1c variability was determined using the standard deviation of all measurements. Lipid profiles were analyzed to identify any correlation with DPN, and data on other diabetic complications were extracted from medical records.

The outcomes found that 51% of the patients (25 out of 49) developed DPN as confirmed by electrophysiological criteria. Over time, nerve conduction studies revealed significant deterioration in the amplitudes and conduction velocities of the median, peroneal and sural nerves. The patients diagnosed with DPN had a markedly longer duration of diabetes, higher wHbA1c and greater variability in HbA1c levels when compared to the individuals without neuropathy.

The study identified that a wHbA1c value of 62 mmol/mol (7.8%) or higher was associated with the development of DPN. No patients with a wHbA1c below this threshold developed neuropathy this highlighted the crucial role of maintaining lower HbA1c levels in preventing long-term complications. The presence of albuminuria and retinopathy was positively correlated with neuropathy which highlighted the interconnected nature of diabetic complications. These findings suggest that rigorous and consistent blood sugar control is essential in mitigating the risk of developing multiple diabetes-related complications.

This extensive study found that over half of the patients with childhood-onset type 1 diabetes developed DPN after 30 years. Also, maintaining a wHbA1c below 62 mmol/mol (7.8%) appears to be a key factor in preventing the onset of neuropathy. This data emphasizes the necessity for ongoing and vigilant diabetes management from an early age to reduce the risk of severe long-term health issues.

Reference:

Baldimtsi, E., Amezcua, S., Ulander, M., Hyllienmark, L., Olausson, H., Ludvigsson, J., & Wahlberg, J. (2024). HbA1c and the risk of developing peripheral neuropathy in childhood‐onset type 1 diabetes: A follow‐up study over 3 decades. In Diabetes/Metabolism Research and Reviews (Vol. 40, Issue 5). Wiley. https://doi.org/10.1002/dmrr.3825