Adolescent Glycemic Control and Long-Term Risks in Type 1 Diabetes
Glycemic control during adolescence may have lasting consequences for adults with type 1 diabetes (T1D). A recent study led by researchers at the University of Michigan suggests that higher blood sugar levels in the teen years are associated with an increased risk of neuropathy later in life, even when childhood and adult glycemic control appear similar. This finding highlights the critical window in adolescence where effective diabetes management can influence long-term outcomes.
What the Study Examined
The international study followed children diagnosed with T1D between 1990 and 1992 who were later part of a long-term cohort evaluating neurovascular and other diabetes-related outcomes. HbA1c data were retrieved from medical records, and neuropathy was assessed decades after diagnosis through clinical screenings and patient-reported information. Among the original 30 participants, about one-third developed neuropathy by early adulthood, while a larger proportion faced other diabetes-related complications such as retinopathy. These results underscore the persistent burden of diabetes complications, even when other factors are controlled or progressive improvements in care occur.
Adolescence as a Critical Window
Analyses revealed that mean HbA1c levels during adolescence were notably higher than those measured in childhood and adulthood. Specifically, adolescence showed an average HbA1c near 9% (74.9 mmol/mol), compared with about 8.2% in childhood and adulthood. Importantly, researchers observed a strong association between greater deviations from an individual’s childhood HbA1c and the risk of developing neuropathy later on. The relative risk of neuropathy increased with larger gaps from one’s early-life glycemic baseline, a signal that adolescence might imprint long-term neural vulnerability.
Interpreting the Findings
What makes these results particularly compelling is that the link between adolescent hyperglycemia and neuropathy persisted even when other diabetes complications did not show the same pattern. Retinopathy and nephropathy did not exhibit the same clear association with adolescent HbA1c, suggesting that neuropathy may be especially sensitive to early blood sugar exposure. The study’s authors caution that multiple factors contribute to neuropathic risk, including vascular factors, yet they emphasize that improving glycemic control during puberty could help reduce this risk trajectory.
Implications for Care and Transition
Healthcare professionals stress the importance of supporting teenagers with T1D to achieve stable glycemic control and to prepare for a seamless transition to adult diabetes care. As Eva Feldman, MD, PhD, highlighted, “This unique study emphasizes the importance of supporting teenagers with type 1 diabetes to manage their blood sugar well and ensure a smooth transition to adult care to prevent future complications.”
Kara Mizokami-Stout, MD, MSc, adds that while vascular risk factors also play a role in neuropathy, the study reinforces the need for intensified efforts to maximize support for younger patients. The transition from pediatric to adult services is a pivotal moment where sustained engagement and education can mitigate future nerve damage risk and improve overall quality of life.
Practical Steps for Parents, Adolescents, and Clinicians
- Set realistic, incremental glycemic targets for adolescence that balance safety with tighter control where possible.
- Enhance access to diabetes education, psychosocial support, and nutrition counseling tailored to teenagers and their families.
- Plan proactive transition programs that begin in adolescence and include coordinated care handoffs to adult endocrinology teams.
- Utilize regular screening for neuropathy and other microvascular complications, with a focus on early detection and intervention.
Ultimately, the study reinforces a simple, powerful idea: preventing neuropathy may start in the teen years. By prioritizing glycemic stability during adolescence and ensuring a strong transition to adult care, patients with type 1 diabetes may lower their lifelong risk of nerve-related complications.
Looking Ahead
As research continues to unravel the complex interplay between glycemia and diabetes complications, clinicians, patients, and families can draw on these findings to advocate for more robust adolescent diabetes care. By aligning medical management with supportive services, the journey from adolescence to adulthood becomes less risky—and possibly less painful—for those living with Type 1 diabetes.
