National Trends in Hyperglycemia and Diabetic Ketoacidosis in Children, Adolescents, and Young Adults With Type 1 Diabetes: A Challenge Due to Age or Stage of Development, or Is New Thinking About Service Provision Needed?

OBJECTIVE: Adolescence is associated with high-risk hyperglycemia. This study examines the phenomenon in a life course context. RESEARCH DESIGN AND METHODS: A total of 93,125 people with type 1 diabetes aged 5 to 30 years were identified from the National Diabetes Audit and/or the National Paediatric Diabetes Audit for England and Wales for 2017/2018–2019/2020. For each audit year, the latest HbA(1c) and hospital admissions for diabetic ketoacidosis (DKA) were identified. Data were analyzed in sequential cohorts by year of age. RESULTS: In childhood, unreported HbA(1c) measurement is uncommon; however, for 19-year-olds, it increases to 22.3% for men and 17.3% for women, and then reduces to 17.9% and 13.1%, respectively, for 30-year-olds. Median HbA(1c) for 9-year-olds is 7.6% (60 mmol/mol) (interquartile range 7.1–8.4%, 54–68 mmol/mol) in boys and 7.7% (61 mmol/mol) (8.0–8.4%, 64–68 mmol/mol) in girls, increasing to 8.7% (72 mmol/mol) (7.5–10.3%, 59–89 mmol/mol) and 8.9% (74 mmol/mol) (7.7–10.6%, 61–92 mmol/mol), respectively, for 19-year-olds before falling to 8.4% (68 mmol/mol) (7.4–9.7%, 57–83 mmol/mol) and 8.2% (66 mmol/mol) (7.3–9.7%, 56–82 mmol/mol), respectively, for 30-year-olds. Annual hospitalization for DKA rose steadily in age from 6 years (2.0% for boys, 1.4% for girls) and peaked at 19 years for men (7.9%) and 18 years for women (12.7%), reducing to 4.3% for men and 5.4% for women at age 30 years. For all ages over 9 years, the prevalence of DKA was higher in female individuals. CONCLUSIONS: HbA(1c) and the prevalence of DKA increase through adolescence and then decline. Measurement of HbA(1c), a marker of clinical review, falls abruptly in the late teenage years. Age-appropriate services are needed to overcome these issues.