Glycemic control in type 1 diabetes not improving in the USA
medwireNews: Just one-fifth of adults, and an even lower proportion of children and adolescents, with type 1 diabetes in the T1D Exchange registry currently meet the ADA target for glycemic control, US researchers report.
Specifically, between 2016 and 2018 only 17% of T1D Exchange registry participants studied met the glycated hemoglobin (HbA1c) target of below 58 mmol/mol (<7.5%) for youths, while 21% met the target of below 53 mmol/mol (<7.0%) for adults.
In addition, “glycemic control has not improved overall between 2010–2012 and 2016–2018 and in fact appears to have worsened particularly in adolescents,” write Nicole Foster (Jaeb Center for Health Research, Tampa, Florida) and co-authors in Diabetes Technology & Therapeutics.
Between 2016 and 2018, mean HbA1c levels among 22,697 T1D exchange registry participants were 65 mmol/mol (8.1%) at the age of 5 years, 78 mmol/mol (9.3%) between ages 15 and 18 years, and then decreased into adulthood, ranging from 58 to 63 mmol/mol (7.5–7.9%) among participants over the age of 30 years.
The values were not significantly different from those observed for 25,529 patients participating in the registry between 2010 and 2012, with the exception of an unexplained rise among adolescents in the later years.
The researchers say the rise “could reflect a difference in diabetes duration between time periods even though duration was adjusted for in analysis or be due to other unmeasured confounding factors.”
“Nevertheless, there is no indication from these data that HbA1c levels in the registry as a whole have improved over this 5-year period despite an increase in the use of insulin pumps and CGM [continuous glucose monitoring],” they add.
Indeed, Foster and team describe the increase in CGM use from 7% in 2010–2012 to 30% in 2016–2018 as “substantial.” Insulin pump use increased from 57% to 63% over the same period.
For both CGM and insulin pumps, the greatest rises in use were seen in children younger than 12 years of age, and the researchers note that in 2016–2018 HbA1c levels were significantly lower in pump and CGM users than nonusers, even after adjustment for age, diabetes duration, race/ethnicity, annual income, and self-monitored blood glucose.
The investigators also found that in 2016–2018 “[r]acial disparities remain in use of technology and in glycemic control,” with non-Hispanic White patients having the highest, and non-Hispanic Black patients the lowest, rates of CGM and pump use, as well as non-Hispanic White patients having the best glycemic control.
Foster and co-authors caution that uninsured and underinsured patients are likely to be underrepresented in the T1D Exchange registry so their findings may not apply to the general population with type 1 diabetes. They also say that the proportion of participants meeting ADA HbA1c targets is likely overestimated, “indicating that glycemic control in a general population of youth and adults with [type 1 diabetes] may be even worse than what was found in the registry.”
The team concludes: “We hope that these data will stimulate further research and efforts to find ways to improve glucose control and bridge the gap in different racial backgrounds.”
By Laura Cowen
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