New Evidence Links Adolescent Hyperglycemia to Adult Neuropathy Risk
Emerging findings from a University of Michigan-led study suggest that poor blood sugar control during adolescence in people with type 1 diabetes (T1D) could increase the likelihood of developing neuropathy in adulthood. This long-term insight adds to the growing body of evidence that early glycemic exposure shapes later diabetes complications, including nerve damage.
The Study: A Long-Term Look at Early Glycemic Control
The research analyzed a cohort of children diagnosed with T1D between 1990 and 1992 who were enrolled in a 30-year longitudinal study in Australia. Researchers tracked HbA1c levels from medical records and assessed microvascular complications through self-reports, clinical screenings, retinal photographs, and urinary albumin-creatinine testing. The cohort began with 30 children, with a mean diabetes diagnosis age of 2.9 years.
After nearly three decades (average 29.7 years), the team found that about one-third of participants developed neuropathy, while a majority showed diabetes-related eye disease, and a smaller portion developed other nerve-related complications. Crucially, higher HbA1c during adolescence, compared with childhood and adulthood, emerged as a key predictor of neuropathy risk in adulthood.
Adolescent HbA1c and Neuropathy: What the Data Show
Mean adolescent HbA1c in the study was 9% (74.9 mmol/mol), significantly higher than HbA1c during childhood and adulthood, which averaged around 8.2% (66.1 mmol/mol). The analysis revealed a significant association between larger deviations from a child’s mean HbA1c and an increased risk of neuropathy in adulthood (relative risk ratio of 7.8; 95% CI, 1.1-57.4; P = .009). Notably, this association was strongest for neuropathy and did not show the same strength for retinopathy or nephropathy in the same timeframe.
These findings imply that adolescent hyperglycemia may exert a lasting impact on nerve health, independent of a patient’s glycemic control earlier in childhood. Even when childhood control is adequate, poor control during adolescence could set the stage for future complications.
Clinical Implications: Support, Transition, and Prevention
The study underscores the importance of actively supporting teenagers with T1D to achieve stable blood sugar levels and to facilitate a smooth transition from pediatric to adult diabetes care. As Dr. Eva Feldman, a senior author and director of the ALS Center of Excellence at the University of Michigan Health, notes, “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.”
Experts also acknowledge that neuropathy is just one facet of a broader vascular risk profile in diabetes. Dr. Kara Mizokami-Stout emphasizes that while glycemic control is a central pillar, other vascular risk factors also contribute to neuropathy development. The takeaway is a comprehensive, proactive approach: prioritizing adolescent glycemic management, ongoing education, psychosocial support, and structured transition programs to adult care teams.
Practical Steps for Families and Clinicians
- Strengthen diabetes education for adolescents to foster independence in self-management.
- Implement regular HbA1c monitoring with actionable targets tailored to adolescence-driven physiology and lifestyle.
- Facilitate structured transition plans that pair young patients with adult care teams well before the transfer date.
- Address psychosocial factors that influence adherence, such as consent, autonomy, and mental health support.
- Integrate neuropathy screening into routine follow-ups as patients age, enabling early detection and intervention.
Looking Ahead: Why Early Control Matters
As diabetes care continues to evolve with technology and evidence-based guidelines, this study reinforces the critical window of adolescence for shaping long-term neuropathy risk. By prioritizing glycemic stability during teenage years and planning seamless transitions to adult care, clinicians and families can potentially reduce the burden of neuropathic complications in adulthood.
Bottom line: Adolescent hyperglycemia in type 1 diabetes may elevate the risk of adult neuropathy. Targeted support during adolescence and careful transition planning to adult care are essential strategies to mitigate future nerve complications and improve lifelong outcomes for people with T1D.
