medwireNews: Results of the SAGE study demonstrate suboptimal glycemic control among adults of all ages with type 1 diabetes across the globe.
The research, presented as two studies at the 55th EASD Annual Meeting in Barcelona, Spain, also showed that glycemic control may vary by age and geographic location.
In the first study, Eric Renard (Montpellier University Hospital, France) and colleagues found that among 3858 patients aged an average 47.8 years, just 24.3% achieved a target glycated hemoglobin (HbA1c) level of lower than 7.0% (53.0 mmol/mol). The average HbA1c level was 7.95% (63.4 mmol/mol).
When patients were categorized by age, those in the youngest age group (26–44 years) were the most likely to achieve target HbA1c levels, with 27.6% of 1724 achieving levels below 7.0%, compared with 21.0% of the 1512 participants aged 45–64 years and 22.8% of the 622 aged 65 years or older.
In the second study, Jochen Seufert (University of Freiburg, Germany) and co-researchers analyzed these results by geographic region, finding that the proportion of people achieving target HbA1c levels below 7.0% was highest in Western Europe (27.0%) and lowest in the Middle East (18.9%).
On the other hand, rates of symptomatic hypoglycemia (≤3.9 mmol/L) were lowest in the Middle East (37.2%) and highest in Western Europe (76.7%), with similarly high rates in Latin America (73.4%) and Eastern Europe (74.9%). Micro- and macrovascular complications occurred most frequently in Europe, with the lowest rates seen in Latin America, the Middle East, and Asia.
The presenters also explored diabetes treatment patterns among the SAGE participants. Renard said that 57.0% of individuals were advised to follow a self-directed insulin-titrated protocol, but just 23.7% titrated their basal insulin at least once weekly. Only 19.9% used insulin pumps, with the highest rates of pump use among people in the youngest age group (24.0%) and the lowest rates in those aged 65 years and older (10.6%).
And in the analysis by geographic region, Seufert reported that the primary method of insulin dose-adjustment was self-titration in Eastern and Western Europe (71.3 and 69.0%, respectively), whereas physician-led titration was more common in Latin America, the Middle East, and Asia (53.1, 72.7, and 56.3%, respectively). The use of insulin pumps was greatest in Western Europe (42.3%) and lowest in the Middle East (2.7%).
Seufert suggested that these variations in treatment strategies may have contributed to regional differences in glycemic control and diabetes complications, with healthcare systems and cultural factors also playing a potential role.
Taken together, the SAGE findings indicate that “further action is required globally to improve HbA1c target in adults with [type 1 diabetes].”
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EASD 2019; Barcelona, Spain: 16–20 September