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Glucose control remained inadequate in a cohort of teens with type 1 diabetes, and many of these young patients already had microvascular complications, a British observational study found.
Among a group of 96 adolescents treated at multidisciplinary young adult clinics, the mean glycosylated hemoglobin (HbA1c) level was 10%, and only 9.4% had levels below the recommended 7.5%, according to Christine Eiser, PhD, of the University of Sheffield, and colleagues.
And in a subgroup who had been diagnosed with type 1 diabetes more than 7 years earlier, 46.9% showed signs of nonproliferative retinopathy, the researchers reported online in Diabetic Medicine.
A retrospective study done a decade ago found that in a group of teens and young adults, glycemic control was suboptimal, clinic visits were sporadic, and complications were common.
The U.K.'s National Institute for Health and Care Excellence has noted that young patients with type 1 diabetes have special concerns that need to be addressed, including mental health problems.
Despite this attention, and advances in treatment, technology, and delivery systems, young patients in the U.K. appeared to be faring worse than those elsewhere in Europe.
To see if that pattern of inadequate disease control persisted, Eiser's group conducted a study between November 2010 and August 2011 that included 60% female participants whose mean age was 18 years.
Depression and anxiety were measured on the Hospital Anxiety and Depression Scale, with a cutoff point of 8 or higher suggesting a clinical diagnosis, and eating disorders were assessed on the Diabetes Eating Problem Survey, with cutoff scores of 2.5 or higher.
Most participants were white and living with their parents, and three-quarters were still in school.
They had been diagnosed an average of 8 years earlier.
A total of 76% were receiving multiple injections each day, 12.5% were on twice-daily insulin, and 11.5% were using insulin pumps.
Mean HbA1c level was higher among girls and young women, at 10.4%, than among their male counterparts, whose mean level was 9.5%.
Levels were lower for those using insulin pumps (9.2%) than for those having multiple daily injections (9.9%) or taking insulin twice daily (11.2%).
Failure to keep clinic appointments was higher, at 13.7%, in those who had been treated at the center for more than 2 years than for those treated for less than a year (10.5%).
Referrals to a clinical psychologist had been made for 21.9%, and 17.9% had kept at least one appointment.
Overall, 26.6% of patients had symptoms of anxiety and 10.9% showed symptoms of depression, while 35.1% had eating disorders.
Girls had higher scores for disordered eating than boys, with average scores of 1.4 compared with 0.6.
Those who scored above the cutoff for depression had higher HbA1c levels, at 11.7%, than those scoring lower, whose mean level was 9.8% (P=0.007).
Among those who had been diagnosed more than 7 years earlier, 94.2% had had an eye exam within the previous year, 92.3% had been screened for nephropathy, and 90.4% were evaluated for hypertension.
Those levels of screening represented an improvement over rates reported in the earlier study, the researchers noted.
A total of 14.6% had an elevated albumin-to-creatinine ratio, 4.2% had microalbuminuria, and 12.8% were hypertensive.
"We have made changes to delivery of care in our clinic to meet current recommendations for transition from pediatrics, multidisciplinary clinics, and psychological support. This has been successful to the extent that some 17.9% of young people accessed psychological support," they observed.
Nonetheless, levels of HbA1c remain too high and complications are frequent.
"Improved technologies offer the potential for better control only when the considerable burden shouldered by young people in assuming responsibility for their self-care and achieving optimal glycemic control is also addressed," they concluded.
The study was funded by the National Institute of Health Research.
The authors reported no conflicts of interest.
- Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner