medwireNews: An update from an international study has shown that although glycemic control has improved with time among people with type 1 diabetes, it remains suboptimal and continues to vary substantially by country, age group, and data source.
Sarah Wild (University of Edinburgh, UK) and co-investigators say their findings “clearly demonstrate the challenge of achieving lower HbA1c [glycated hemoglobin] targets to minimise the risk of developing long-term complications.”
Wild and team analyzed data for 520,392 children and adults with type 1 diabetes from population-based registries or individual clinics in 22 countries between 2016 and 2020.
The participants had a median HbA1c that ranged from 7.2% to 9.4% (55 to 79 mmol/mol) depending on age and data source, both of which were significantly associated with the likelihood of achieving a target HbA1c below 7.5% (58 mmol/mol).
Specifically, individuals younger than 15 years old were a significant 1.68 times more likely to meet the HbA1c target than those aged 25 years and older. Conversely, people aged 15–24 years were a significant 19% less likely to meet the target than older participants.
This finding reinforces “existing knowledge that adolescence and early adulthood is a particularly challenging time for managing type 1 diabetes and that there is considerable scope for improving glycaemic control in this age group in most populations,” write Wild and co-authors in Diabetic Medicine.
The researchers also found that median HbA1c was a significant 1.24 times more likely to be below 7.5% in data provided by clinics compared with population-based data.
When the team compared the current findings with data from a similar study they conducted between 2010 and 2012, they observed that the proportion of people with an HbA1c below 7.5% had generally increased with time while the proportion with an HbA1c of 9.0% or higher had decreased.
For example, in England, 18.0% of participants had an HbA1c below 7.5% in 2010–2012 compared with 40.0% in 2016–2020, while a respective 32.8% and 13.8% had an HbA1c at or above 9.0%.
Similar patterns were seen in Denmark, the Netherlands, and Wales, whereas there were much smaller changes over time in Australia, Austria, Germany, and Latvia. In Italy, the proportion with an HbA1c below 7.5% increased from 41.3% to 59.4% but the proportion with an HbA1c of 9.0% or higher also increased, from 9.8% to 13.0%.
Wild et al say that some of the improvements might “be explained by the extent of introduction of new technologies,” particularly as the proportions using continuous subcutaneous insulin infusion (CSII) varied widely among the data sources, even in the youngest age group.
In spite of this, the authors note that they “did not observe any association between proportions of each population using CSII and median HbA1c.”
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Diabet Med 2021; doi:10.1111/dme.14766