Treatment adherence and BMI reduction are key predictors of HbA1c one year after diagnosis of childhood Type 2 Diabetes in UK

BACKGROUND: Type 2 Diabetes (T2DM) is increasing in childhood especially among females and South-Asians.

OBJECTIVE: To report outcomes from a national cohort of children and adolescents with T2DM one year following diagnosis SUBJECTS AND METHODS: Clinician reported, one-year follow-up of a cohort of children (<17years) diagnosed with T2DM reported through British Paediatric Surveillance Unit (April 2015-April 2016).

RESULTS: One hundred (94%) of 106 baseline cases were available for review. Of these, five were lost to follow up and one had a revised diagnosis. Mean age at follow up was 15.3 years. Median BMI SDS was 2.81 with a decrease of 0.13 SDS over a year. HbA1c <48mmol/mol (UK target) was achieved in 38.8%. logHbA1c was predicted by clinician reported compliance and attendance concerns (β=0.12 p=<0.0001) and change in BMI SDS at 1-year (β=0.13, p=0.007). In over 50%, clinicians reported issues with compliance and attendance. Mean clinic attendance was 75%. Metformin was the most frequently used treatment at baseline (77%) and follow-up (87%). Microalbuminuria prevalence at 1-year was 16.4% compared to 4.2% at baseline and was associated with a higher HbA1c compared to those without microalbuminuria (49 vs 60 mmol/mol, p=0.03).

CONCLUSIONS: Adherence to treatment and a reduction in BMI appear key to better outcomes a year after T2DM diagnosis. Retention and clinic attendance are concerning. The prevalence of microalbuminuria has increased four-fold in the year following diagnosis and was associated with higher HbA1c. This article is protected by copyright. All rights reserved.