O-41: Early type 1 diabetes detection and DKA avoidance are associated with lower A1C trajectory
G T Alonso, H Salman, A Stein, M Rewers, K Simmons, H Broncucia, A Steck, B FrohnertAbstract
Introduction
Diabetic ketoacidosis (DKA) at stage 3 type 1 diabetes (T1D) diagnosis is associated with worse long-term glycemic outcomes. Screening for early-stage T1D greatly reduces DKA risk but benefit from screening on long-term glycemic control remains unclear.
Objectives
To determine whether screening for early-stage T1D predicts lower A1c trajectories after diagnosis.
Methods
Children diagnosed with stage 3 T1D (2005–2021) were classified as screened and monitored, screened only, and community-diagnosed with vs without DKA; screened subgroups were not further stratified by DKA due to few DKA events. A1c trajectories over 6 years were examined using LOESS and linear mixed-effects models adjusted for age, race, sex, and time from diagnosis.
Results
At stage 3 diagnosis, mean A1c differed across groups: 7.3±2.1% screened and monitored; 9.2±3.2% screened only; 11.3±2.5% community without DKA; 12.5±1.9% community with DKA (p<0.001). A1c converged during partial remission (6-12 months) (Figure). Screened and monitored patients had lower A1c than patients diagnosed with DKA starting at 12 months (∼0.3%) and increasing by 5–6 years (∼0.5%) (all p≤0.01). In adjusted models, DKA at stage 3 diagnosis independently predicted higher A1c (β=0.23%, 95% CI 0.15–0.31; p<0.0001) as did community diagnosis (β=0.24%, p<0.05). In children <13 years, higher A1c was driven by differences between screened and monitored and community diagnosed with DKA; no differences were seen among older children. Continuous glucose monitor use and more recent diagnosis year predicted lower A1c (both p<0.001).
Conclusions
Avoiding DKA at stage 3 T1D predicted lower long-term A1c, especially in younger children. Screening and monitoring for early T1D may confer long-term benefit beyond DKA prevention.