Diabetes Dateline
Fall 2009

Research News

Poor Glycemic Control Common among Children with Diabetes

A substantial portion of U.S. children with diabetes have poor glycemic control, according to findings by the SEARCH for Diabetes in Youth Study Group and published in July 2009 in The Journal of Pediatrics.

“Further research is urgently needed to establish interventions that meld efficacious technology with effective behavioral and social approaches to improve glycemic control for the highly diverse group of youth living with diabetes,” wrote Diana B. Petitti, M.D., Ph.D., a professor at Arizona State University, and co-authors, for the SEARCH Study Group.

Maintaining near-normal glycemic control, also known as blood glucose control, is an important step in limiting complications of diabetes, a condition that affects the body’s ability to make or use insulin. Insulin is a hormone that regulates blood glucose, also called blood sugar.

SEARCH, the largest and most comprehensive study of type 1 and type 2 diabetes among U.S. children, is sponsored by the U.S. Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Comprising study centers in six U.S. regions, SEARCH is an ongoing, population-based study designed to reflect the nation’s diversity.

Type 1 diabetes results from an autoimmune attack that kills pancreatic beta cells, which make insulin. People with type 2 diabetes are less sensitive to insulin, called insulin resistance. Type 2 diabetes is associated with obesity, high blood pressure, and a sedentary lifestyle. Both type 1 and type 2 diabetes cause high blood glucose levels, or hyperglycemia, which over time can lead to eye, nerve, and kidney damage and increase the risk of heart attack and stroke.

SEARCH collects data through networks maintained by endocrinologists, hospitals, and health plans. Patient participants complete a physical exam and a detailed medical history questionnaire and donate blood and urine for biochemical and genetic analyses. In 2008, SEARCH reported that about 154,000 children in the United States have some form of diabetes.

In the current analysis, SEARCH investigators examined data from 3,947 children with type 1 diabetes and 552 children with type 2 diabetes. Based on results of hemoglobin A1c (A1C) tests, which reflect average blood glucose levels from the previous 2 to 3 months, SEARCH found that 17 percent of children with type 1 diabetes and 27 percent with type 2 diabetes had poor glycemic control, which is defined as an A1C level greater than 9 percent.

Ethnic minorities, including African Americans, American Indians, Hispanics/Latinos, and Asian and Pacific Islander Americans, had significantly worse glycemic control compared with Caucasians. Other SEARCH analyses are dissecting the sociodemographic, economic, and biological factors that likely account for these disparities.

The investigators also found that glycemic control tended to worsen with age and longer disease duration. Among patients age 19 and older, 29 percent of those with type 1 diabetes and 47 percent of those with type 2 diabetes exhibited poor glycemic control.

The study’s findings are “particularly disturbing,” according to Petitti and co-authors, “given that almost all of the youth were insured and all were motivated to volunteer for research.” Presumably, these individuals and their parents represent a segment of the population that is more proactive about diabetes. The study suggests glycemic control may be even worse in the general population of youth with diabetes.

Possible factors that might hinder children’s ability to meet A1C targets, compared with adults, include underlying metabolic differences, fluctuation of hormones during adolescence, fear of hypoglycemia—or low blood sugar—and behavior that decreases treatment compliance. Going forward, SEARCH will closely examine these factors to identify better therapeutic strategies.

For more information about the SEARCH for Diabetes in Youth Study, visit www.searchfordiabetes.org.

The National Diabetes Information Clearinghouse, an information dissemination service of the NIDDK, has fact sheets and easy-to-read booklets about diabetes. For more information, visit www.diabetes.niddk.nih.gov.

NIH Publication No. 10–4562
November 2009

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