Articles

Posted Apr 19 , 2019 09:05 AM

State of Type 1 Diabetes Management and Outcomes from the T1D Exchange in 2016–2018

Foster NC, et al. Diabetes Technology and Therapeutics 2019;21:1-7

Institute Summary (excerpted from the Abstract):

The purpose of this article is to provide a snapshot of the profile of adults and youth with type 1 diabetes (T1D) in the United States and assessment of longitudinal changes in T1D management and clinical outcomes in the T1D Exchange registry. Data on diabetes management and outcomes from 22,697 registry participants (age 1–93 years) were collected between 2016 and 2018 and compared with data collected in 2010–2012 for 25,529 registry participants. Mean HbA1c in 2016–2018 increased from 8.1% (65 mmol/mol)) at the age of 5 years to 9.3% (78 mmol/mol)) between ages 15 and 18, with a decrease to 8.0% (64 mmol/mol) by age 28 and 7.5-5.9% (58–63 mmol/mol) beyond age 30. The American Diabetes Association (ADA) HbA1c goal of <7.5% (58 mmol/mol) for youth was achieved by only 17% and the goal of <7.0% (53 mmol/mol) for adults by only 21%. Mean HbA1c levels changed little between 2010–2012 and 2016–2018, except in adolescents who had a higher mean HbA1c in 2016–2018. Insulin pump use increased from 57% in 2010–2012 to 63% in 2016–2018. Continuous glucose monitoring (CGM) increased from 7% in 2010–2012 to 30% in 2016–2018, rising >10-fold in children <12 years old. HbA1c levels were lower in CGM users than nonusers. Severe hypoglycemia was most frequent in participants >50 years old and diabetic ketoacidosis was most common in adolescents and young adults. Racial differences were evident in use of pumps and CGM and HbA1c levels. (For those unfamiliar with the HbA1c designation in mmol/mol recommended by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) a conversion application can be found here: https://www.hba1cnet.com/hba1c-calculator/)

Why is this important?

Data from the T1D Exchange registry demonstrate that only a minority of adults and youth with T1D in the United States achieve ADA goals for HbA1c. Several pieces of data are impressive in this summary. First, the use of CGM in individuals with T1D has increased strikingly due not only to availability of several CGM options, but also to third party and Medicare coverage most recently. Additionally, the use of insulin pumps has increased significantly. And, as might be expected, HbA1c levels were lower in pump and CGM users. Also, as seen in other studies, increasing frequency of SMBG was associated with lower HbA1c levels as well. The data show that roughly half of the T1D patients were overweight or obese, which parallels the prevalence in the non-diabetic population. A surprising finding was that mean HbA1c levels have increased from 2010–2012 to 2016–2018 in teens and emerging adults. As shown previously, severe hypoglycemia occurs more commonly in older adults than in younger participants, particularly those with long duration of T1D. This finding is vital to the argument for coverage of CGM technology for older patients and those on Medicare. There is a wealth of information about the current ‘State of the Art’ in patients with T1D in this article and its supplementary material!

Read the Article:
https://www.liebertpub.com/doi/pdf/10.1089/dia.2018.0384  (NOTE: The online version has links to several supplementary tables)

Read the Commentary:
https://www.liebertpub.com/doi/pdf/10.1089/dia.2019.0008