Ann Pediatr Endocrinol Metab.  2024 Aug;29(4):242-249. 10.6065/apem.2346180.090.

Long-term tracking of glycosylated hemoglobin levels across the lifespan in type 1 diabetes: from infants to young adults

• Kim S
• Kim SJ
• Cho KW
• Song K
• Lee M
• Suh J
• Chae HW
• Kim HS
• Kwon A

• KMID: 2559452
• DOI: http://doi.org/10.6065/apem.2346180.090

Abstract

Purpose
Glycosylated hemoglobin (HbA1c) is commonly used as a monitoring tool in diabetes. Due to the potential influence of insulin resistance (IR), HbA1c level may fluctuate over a person's lifetime. This study explores the long-term tracking of HbA1c level in individuals diagnosed with type 1 diabetes mellitus (T1DM) from infancy to early adulthood.
Methods
The HbA1c levels in 275 individuals (121 males, 43.8%) diagnosed with T1DM were tracked for an average of 9.4 years. The distribution of HbA1c levels was evaluated according to age with subgroups divided by gender, use of continuous glucose monitoring (CGM), and the presence of complications.
Results
HbA1c levels were highest at the age of 1 year and then declined until age 4, followed by a significant increase, reaching a maximum at ages 15–16 years. The levels subsequently gradually decreased until early adulthood. This pattern was observed in both sexes, but it was more pronounced in females. Additionally, HbA1c levels were higher in CGM nonusers compared with CGM users; however, regardless of CGM usage, an age-dependent pattern was observed. Furthermore, diabetic complications occurred in 26.8% of individuals, and the age-dependent pattern was observed irrespective of diabetic complications, although HbA1c levels were higher in individuals with diabetic complications.
Conclusion
HbA1c levels vary throughout the lifespan, with higher levels during adolescence. This trend is observed regardless of sex and CGM usage, potentially due to physiological IR observed during adolescence. Hence, physiological IR should be considered when interpretating HbA1c levels during adolescence.

Keyword

Type 1 diabetes mellitus; Adolescents; HbA1c; Age; Sex; Insulin resistance

Figure

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  Fig. 1. Study selection and baseline population. DM, diabetes mellitus; MODY, Maturity-Onset Diabetes of the Young.

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  Fig. 2. Trajectory of HbA1c levels across age groups. (A) Total participants. (B) Groups divided by sex. HbA1c, glycosylated hemoglobin.

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  Fig. 3. Trajectory of HbA1c levels across age groups according to CGM use. HbA1c, glycosylated hemoglobin; CGM, Continuous glucose monitoring.

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  Fig. 4. Trajectory of HbA1c levels across age groups according to diabetic complications. (A) Diabetic complications. (B) Diabetic retinopathy. (C) Diabetic nephropathy. (D) Diabetic neuropathy. HbA1c, glycosylated hemoglobin.

Reference

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