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Peer-reviewedCC BY-NC 4.0BMJ Open

Differences in A1C trajectory by sex and BMI in paediatric type 1 diabetes: a retrospective cohort study using a diabetes registry in British Columbia, Canada

  • Joseph MWS Leung1,2
  • Melissa Braschel3
  • Jeffrey N Bone3,4
  • Shazhan Amed3,5
5 affiliations
  1. 1Department of Medicine, Division of Endocrinology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
  2. 2Vancouver General Hospital, Vancouver, British Columbia, Canada
  3. 3BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
  4. 4Department of Obstetrics and Gynecology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
  5. 5Department of Pediatrics, Division of Endocrinology and Diabetes, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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Abstract

Objectives: To determine if there are differences in Hemoglobin A1C (A1C) trajectory by sex among children and youth living with type 1 diabetes and to examine how this would be modified by body mass index (BMI).

Design: Retrospective cohort study using the British Columbia Pediatric Diabetes Registry (BC-PDR), a provincial paediatric diabetes registry that started enrolling patients in 2017 and included data up to 2 years prior to enrolment.

Setting: Data were extracted from the BC-PDR (British Columbia, Canada) in July 2023 and included data from 2016 to 2023.

Participants: 674 individuals diagnosed with type 1 diabetes in childhood and adolescence (299 females, 375 males).

Primary and secondary outcome measures: We extracted demographic data, clinical characteristics and longitudinal A1C values from the BC-PDR. We plotted A1C trajectories by sex and BMI categories. We used generalised additive models to flexibly examine A1C trajectories by age and compared these by sex. We further examined whether the association between age- and sex-specific A1C differed between BMI categories.

Results: At age 5, there was no difference in mean A1C by sex (mean difference=−0.03%, 95% CI −0.21% to 0.15%, p=0.73), but by age 14, males had a lower mean A1C compared with females (mean difference=0.15%, 95% CI 0.04% to 0.25%, p=0.01). This difference was even greater by age 18 (mean difference=0.77%, 95% CI 0.59% to 0.94%, p<0.001). Mean A1Cs were higher in females with a BMI in the overweight and obese categories starting at age 15, with no sex difference in those with a normal BMI.

Conclusions: In those living with type 1 diabetes, the A1C rise in the teenage years is largely driven by females with a BMI in the overweight and obese categories. Further research is needed to understand the interplay between age, sex, A1C and BMI among children and youth living with type 1 diabetes.

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Cite

BibTeXRIS
BibTeX
@article{leung2026differences,
  title = {{Differences in A1C trajectory by sex and BMI in paediatric type 1 diabetes: a retrospective cohort study using a diabetes registry in British Columbia, Canada}},
  author = {Joseph MWS Leung and Melissa Braschel and Jeffrey N Bone and Shazhan Amed},
  journal = {BMJ Open},
  year = {2026},
  month = oct,
  doi = {10.1136/bmjopen-2026-122858},
  url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-122858},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Differences in A1C trajectory by sex and BMI in paediatric type 1 diabetes: a retrospective cohort study using a diabetes registry in British Columbia, Canada
AU  - Joseph MWS Leung
AU  - Melissa Braschel
AU  - Jeffrey N Bone
AU  - Shazhan Amed
PY  - 2026
DA  - 2026/10/27
JO  - BMJ Open
DO  - 10.1136/bmjopen-2026-122858
UR  - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-122858
AB  - Objectives: To determine if there are differences in Hemoglobin A1C (A1C) trajectory by sex among children and youth living with type 1 diabetes and to examine how this would be modified by body mass index (BMI).  Design: Retrospective cohort study using the British Columbia Pediatric Diabetes Registry (BC-PDR), a provincial paediatric diabetes registry that started enrolling patients in 2017 and included data up to 2 years prior to enrolment.  Setting: Data were extracted from the BC-PDR (British Columbia, Canada) in July 2023 and included data from 2016 to 2023.  Participants: 674 individuals diagnosed with type 1 diabetes in childhood and adolescence (299 females, 375 males).  Primary and secondary outcome measures: We extracted demographic data, clinical characteristics and longitudinal A1C values from the BC-PDR. We plotted A1C trajectories by sex and BMI categories. We used generalised additive models to flexibly examine A1C trajectories by age and compared these by sex. We further examined whether the association between age- and sex-specific A1C differed between BMI categories.  Results: At age 5, there was no difference in mean A1C by sex (mean difference=−0.03%, 95% CI −0.21% to 0.15%, p=0.73), but by age 14, males had a lower mean A1C compared with females (mean difference=0.15%, 95% CI 0.04% to 0.25%, p=0.01). This difference was even greater by age 18 (mean difference=0.77%, 95% CI 0.59% to 0.94%, p<0.001). Mean A1Cs were higher in females with a BMI in the overweight and obese categories starting at age 15, with no sex difference in those with a normal BMI.  Conclusions: In those living with type 1 diabetes, the A1C rise in the teenage years is largely driven by females with a BMI in the overweight and obese categories. Further research is needed to understand the interplay between age, sex, A1C and BMI among children and youth living with type 1 diabetes.
SN  - 2044-6055
SN  - 2044-6055
ER  -