Glycemic control and complications in patients with type 1 diabetes-a registry-based longitudinal study of adolescents and young adults

ObjectiveThe main aims of this study were to assess longitudinal glycemic control and the prevalence of retinopathy and nephropathy in young people (aged 14-30yr) with type 1 diabetes in Norway. MethodData on 874 patients were obtained by linking two nationwide, population-based medical quality registries: The Norwegian Diabetes Register for Adults and The Norwegian Childhood Diabetes Registry. ResultsMedian age was 23yr, median diabetes duration 9yr and 51% were male. Median HbA(1c) increased through adolescence to peak at ages of 17yr for females and 19yr for males, females had higher HbA(1c) than males: 9.3% (78mmol/mol) vs. 9.1% (76mmol/mol). Subsequently, median HbA(1c) declined but was still >8% (>64mmol/mol) for patients approaching 30yr. Half of the patients aged 14-17yr and 40% of patients aged 18-25yr had HbA(1c) >9% (75mmol/mol). Retinopathy was found in 16% and nephropathy in 13% of the population. Patients transferring from the pediatric department to adult care between the ages of 14 and 17yr had higher median HbA(1c) and prevalence of late complications than those transferring at ages 18-22yr. Less than 40% of patients with albuminuria were treated with ACE inhibitors or angiotensin II receptor blocker. ConclusionOur results demonstrate that treatment of adolescents and young adults with type 1 diabetes in Norway is not optimal, especially for patients in their late teens. We suggest that pediatricians and endocrinologists should critically assess the care offered to this group and consider new approaches to help them improve glycemic control.