Three-Variate Longitudinal Patterns of Metabolic Control, Body Mass Index, and Insulin Dose during Puberty in a Type 1 Diabetes Cohort: A Group-Based Multitrajectory Analysis - 20/02/20
, Oliver Kuss, PhD 2, 3, 4, Desiree Dunstheimer, MD 5, Beate Karges, MD, PhD 6, Thomas Kapellen, MD, PhD 7, Thomas Meissner, MD 8, Michael Witsch, MD 9, Monika Flury, MD 10, Stefanie Straubinger, MD 11, Reinhard W. Holl, MD, PhD 1, 2for the
Diabetes-Patienten-Verlaufsdokumentation (DPV) Initiative
Abstract |
Objective |
To analyze the interrelationship of metabolic control, age- and sex-adjusted body mass index, and daily insulin dose and to identify heterogeneous multivariate developmental curves from childhood to young adulthood in a large cohort of children with type 1 diabetes (T1D)
Study design |
Data were extracted from the diabetes follow-up registry DPV. Longitudinal data from 9239 participants with T1D age 8-18 years with diabetes duration ≥2 years and ≥5 years of follow-up were analyzed. We applied group-based multitrajectory modeling to identify latent groups of subjects following similar developmental curves across outcomes (hemoglobin A1c [HbA1c], age/sex-standardized body mass index [BMI-SDS], daily insulin dose per kg). Group number was based on Bayes information criterion and group size (≥5%).
Results |
The group-based multitrajectory approach revealed 5 heterogeneous 3-variate trajectories during puberty. Individuals with stable good metabolic control, high-normal increasing BMI-SDS, and rising insulin dose patterns were classified as group 1 (33%). Group 2 (20%) comprised youths with intermediate-increasing HbA1c, low BMI-SDS, and steeply increasing insulin dose trajectories. Group 3 (11%) followed intermediate-rising HbA1c and high-normal increasing BMI-SDS developmental curves, while insulin dose increased steeply. In group 4 (14%), both high-increasing HbA1c and insulin dose trajectories were observed, while BMI-SDS was stable-normal. Group 5 (22%) included subjects with intermediate-rising HbA1c patterns, high-increasing BMI-SDS, and increasing insulin dose patterns.
Conclusions |
This study identified 5 distinct 3-variate curves of HbA1c, BMI-SDS, and insulin dose during puberty among youths with T1D. This approach demonstrates a considerable heterogeneity highlighting the importance of personalized medical care.
Le texte complet de cet article est disponible en PDF.Keywords : multitrajectory group-based modeling, type 1 diabetes, puberty, HbA1c, body mass index, insulin dose
Abbreviations : BMI, CGM, DPV, GBMT, GBT, HbA1c, KiGGS, SMBG, T1D
Plan
| The DPV is supported through the German Federal Ministry for Education and Research within the German Center for Diabetes Research (DZD, grant number: 82DZD0017G). Further financial support was received by the German Robert Koch Institute (RKI) and the German Diabetes Association (DDG). Sponsors were not involved in study design, collection, analysis and interpretation of data, writing of the report, and the decision to submit the manuscript for publication. T.K. receives grants from EU Horizon 2020, from null, outside the submitted work. The other authors declare no conflicts of interest. |
Vol 218
P. 64 - mars 2020 Retour au numéro
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