What question did this study set out to answer?

The study aims to identify distinct hemoglobin A1c trajectories after the onset of type 2 diabetes in youth.

June 13, 2026

2089-P: Hemoglobin A1c Trajectories from Diabetes Onset in Youth with Type 2 Diabetes (T2D)

Key Points

The study aims to identify distinct hemoglobin A1c trajectories after the onset of type 2 diabetes in youth.
Youth aged 8-20 years diagnosed with type 2 diabetes between 2011 and 2025 were analyzed.
Clustering analysis was conducted on A1c trajectory features over 5 years post-diagnosis.
Demographic and clinical characteristics were compared, and multivariable regression analyses identified predictors of complications.
Three distinct A1c trajectories were identified, with demographic differences observed across groups.
Youth in intermediate and high trajectories were significantly more likely to require insulin at 2 and 5 years post-diagnosis (p<0.001).
High A1c trajectory is a strong predictor of diabetic ketoacidosis.

Abstract

Introduction and Objective: Distinct A1c trajectories in youth with type 1 diabetes are associated with specific outcomes. Whether such trajectories exist in youth with T2D is unknown. We aimed to identify A1c trajectories after T2D onset in youth. Methods: Youth with T2D aged 8-20 years and diagnosed between 2011 and 2025 were identified from electronic medical records at a tertiary care center. Clustering analysis using A1c trajectory features (baseline, mean, slope, and change) identified patterns over 5 years after diagnosis. Demographic and clinical characteristics were compared across trajectories, and multivariable regression analyses identified predictors of diabetic complications. Results: The cohort included 2,449 youth (41.8% male, 58.3% Hispanic, 28.1% African American) with mean A1c at diagnosis of 8.7%. Three A1c trajectories were identified (Figure). Compared to the low A1c trajectory, the intermediate and high trajectories included higher proportions of African American and male youth (p0.001, both). Youth in these trajectories were more likely to require insulin at 2 and 5 years after diagnosis (p0.001, both). Belonging to the high A1c trajectory was among the strongest predictors of diabetic ketoacidosis. Conclusion: Distinct A1c trajectories occur after T2D onset in youth and are associated with demographic and clinical differences. Early identification of high-risk youth may help guide monitoring and targeted interventions. Disclosure A. Kadi: None. D. Palacios: None. S. Aras: None. L. Sobhi: None. H. Chen: None. Z. Liu: None. M.J. Redondo: Advisory Panel; Current; Sanofi. Other - Data Safety Monitoring committee; Current; Lilly. M. Tosur: None. Funding National Institutes of Health (3 U24 DK097771-12S1)

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