Elsevier

The Journal of Pediatrics

Volume 155, Issue 5, November 2009, Pages 668-672.e3
The Journal of Pediatrics

Original Article
Glycemic Control in Youth with Diabetes: The SEARCH for Diabetes in Youth Study

https://doi.org/10.1016/j.jpeds.2009.05.025Get rights and content

Objective

To assess correlates of glycemic control in a diverse population of children and youth with diabetes.

Study design

This was a cross-sectional analysis of data from a 6-center US study of diabetes in youth, including 3947 individuals with type 1 diabetes (T1D) and 552 with type 2 diabetes (T2D), using hemoglobin A1c (HbA1c) levels to assess glycemic control.

Results

HbA1c levels reflecting poor glycemic control (HbA1c ≥ 9.5%) were found in 17% of youth with T1D and in 27% of those with T2D. African-American, American Indian, Hispanic, and Asian/Pacific Islander youth with T1D were significantly more likely to have higher HbA1c levels compared with non-Hispanic white youth (with respective rates for poor glycemic control of 36%, 52%, 27%, and 26% vs 12%). Similarly poor control in these 4 racial/ethnic groups was found in youth with T2D. Longer duration of diabetes was significantly asso∗ciated with poorer glycemic control in youth with T1D and T2D.

Conclusions

The high percentage of US youth with HbA1c levels above the target value and with poor glycemic control indicates an urgent need for effective treatment strategies to improve metabolic status in youth with diabetes.

Section snippets

Methods

The SEARCH for Diabetes in Youth Study is ongoing at 6 study centers in the United States, with the goal of describing the epidemiology of childhood diabetes according to race/ethnicity, age, sex, and diabetes type. The study design has been published previously.9 It involves identifying existing (prevalent) cases of nongestational diabetes in patients under age 20 years in 2001 and newly diagnosed (incident) cases in subsequent calendar years, with the goal of complete case ascertainment in

Results

The overall mean HbA1c value was 8.18% ± 1.59% for youth with T1D and 7.99% ± 2.51% for youth with T2D. Overall, 17% of the youth with T1D and 27% of those with T2D had poor glycemic control (ie, HbA1c ≥ 9.5%) (Table I; available at www.jpeds.com). For both T1D and T2D, the percentage of youth above the age-specific target HbA1c was higher with increasing age at the time of the SEARCH examination. In those age 19+ years, 29% of those with T1D and 47% of those with T2D exhibited poor glycemic

Discussion

A high proportion of children and youth with diabetes in this study exhibited poor HbA1c values. This finding is particularly disturbing given that almost all of the youth were insured and all were motivated to volunteer for research.

Our finding of poor glycemic control in youth with T1D is similar to published data from other countries.8, 16 In these countries, there were center variations in glycemic control that were not explained by demographic or clinical factors. It has been suggested

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  • Cited by (0)

    Funding and conflict of interest information available at www.jpeds.com (Appendix 2).

    A complete list of the members of the SEARCH for Diabetes in Youth Study Group is available at www.jpeds.com (Appendix 1).

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