A new trial has identified several ways to improve glycemic control in young people with type 1 diabetes.
As insulin requirements change over time, managing type 1 diabetes in the first two decades of life is a challenge. A study conducted by researchers at Joslin Diabetes Center and Harvard Medical School identified clear predictors of increased A1C levels in young people, as well as ways to improve glycemic control in this population. The essay was published by Diabetic Medicine.
20 years of analysis
Poor blood sugar control and deteriorating A1C levels are common in children and adolescents with type 1 diabetes. “Fewer than one in five children and adolescents reach target A1C levels.” explains Lori Laffel, author of the study.
For this study, the researchers studied over 20 years the changes in insulin doses and A1C levels in 635 young people, aged 7 to 24, all with type 1 diabetes. The researchers evaluated the dose of insulin and blood sugar control by gender, insulin diet, and body weight (normal or obese).
The difference according to the sexes
Researchers found that in late adolescence and early adulthood (16 to 24 years old), A1C levels were higher in women than in men. Insulin doses were higher in women than in men at younger ages, between 8 and 13 years old, while they were higher in men than in women between 16 and 21 years old.
“We need to deal with the deterioration in blood sugar that appears in the second half of teenage life and early twenties, especially in female patients,” Lori Laffel said. “The study confirms that we may need to give women more insulin during times when A1C levels are rising, or to treat other aspects of diabetes care, such as diet and exercise, to improve A1C levels “.
Insulin pump
The study also showed that insulin pump users compared to injected patients needed lower doses of insulin and had lower A1C levels over time. “The insulin delivered by a pump can control blood sugar more effectively, with a lower insulin dose. On the other hand, people who use an insulin pump may find it easier to manage their diabetes. in a timely manner, which leads to better blood sugar control with lower doses of insulin, ”notes Lori Laffel.
In case of overweight?
In contrast, there was no difference in A1C levels between overweight or obese patients and normal-weight patients. However, obese and overweight young people took higher doses of insulin between the ages of 8 and 13. “These results suggest that insulin resistance, which generally occurs in association with the growth and development of puberty, may develop at a younger age when young people are overweight or obese. Clinicians should be older. proactive in adjusting insulin doses to prevent the deterioration of A1C in these young people, ”concludes Lori Laffel.
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