Predictors of glycemic control and short-term adverse outcomes in youth with type 1 diabetes

Objectives: To examine predictors of glycemic control and to assess how gly cemic control affects the incidence of short-term adverse outcomes in a ped iatric population with type 1 diabetes. Study design: Three hundred youth, aged 7 to 16 years, with type 1 diabetes who were receiving diabetes specialty care were followed up prospectively for 1 year. Treatment plans and frequency of adverse outcomes were ascertai ned by questionnaires and medical record review. Incidence rates of adverse outcomes were compared among 3 strata of the population, representing tert iles of baseline glycosylated hemoglobin (HbA1c). Results: Blood glucose monitoring frequency was the sole modifiable predict or of HbA1c (P <.0001). Overall incidence rate of hospitalization was 13 pe r 100 person-years, more than 3 times the rate in the general pediatric pop ulation and significantly higher in the upper HbA1c tertile compared with t he other strata (P =.001). Rate of emergency department use was 29 per 100 person-years and did not differ significantly among tertiles. Incidence of severe hypoglycemia was 62 per 100 person-years and notably high even in th ose with poorest glycemic control. Conclusion: Despite improvements in diabetes care, the incidence of shortte rm adverse events in children with type 1 diabetes remains high, particular ly in those with poorest glycemic control.