Quarterly Visits with Glycated Hemoglobin Monitoring: The Sweet Spot for Glycemic Control in Youth with Type 1 Diabetes

  1. Lloyd N. Werk, MD, MPH4
  1. 1Nemours Weight Management Division,
  2. 2Nemours Division of Bioinformatics,
  3. 3Nemours Office of Quality and Safety, Alfred I. duPont Hospital for Children, Wilmington, DE;
  4. 4Nemours Office of Quality and Safety, Nemours Children’s Hospital, Orlando, FL
  1. Corresponding Author: Lloyd N. Werk, E-mail: lloyd.werk{at}


Objective To evaluate the association between the frequency of visits and glycated hemoglobin (GHb) measurements on glycemic control in youth with type 1 diabetes. Research Design and Methods: A retrospective longitudinal cohort study of 1449 youth (mean age 11.4 years, 50% female, 74% Caucasian, 24% with Medicaid) with type 1 diabetes followed at five pediatric endocrinology clinics from the years 2008 to 2011 was conducted. Utilizing hierarchical cluster analysis, three homogeneous groups of patients were generated: those with a relative increase in GHb (worsened, n = 237), no change in GHb (stable, n = 842), and decrease in GHb (improved, n = 370) over the study period. The number of visits and GHb obtained per year were compared between the three groups utilizing multinomial logistic regression analysis, using one visit or GHb per year as a reference and controlling for patient demographic and baseline characteristics. Results: Patients with quarterly visits were least likely to have worsened glycemic control (OR 0.33, p < 0 .05) and were most likely to have improved glycemic control (OR 3.48, p < 0.01). Patients with four GHb tests a year (OR 0.53, p < 0.05) were least likely to have worsened glycemic control. Conclusion: Quarterly visits and GHb testing are associated with glycemic control in youth with type 1 diabetes.

  • Received April 25, 2013.
  • Accepted September 18, 2013.

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This Article

  1. Diabetes Care
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