Just 21 percent of adults and 17 percent of children and adolescents living with type 1 diabetes (T1D) meet the treatment goals outlined by the American Diabetes Association, according to a study published Jan. 18 in Diabetes Technology & Therapeutics.
The study provides the first glimpse into five-year outcomes from the T1D Exchange clinical registry, a database launched in 2010 that records the clinical characteristics and outcomes of T1D in American patients. Nicole C. Foster, MS, of the Jaeb Center for Health Research in Tampa, Florida, and colleagues compared management and outcomes data from the registry’s baseline to data collected between 2016 and 2018.
According to the ADA, adults with T1D should maintain their levels of glycated hemoglobin—or HbA1c—below 53 mmol/mol to stay healthy, and youth shouldn’t dip below an HbA1c of 58 mmol/mol. Foster and her team found that average HbA1c levels didn’t change much between 2010-2012 and 2016-2018, but adolescents demonstrated considerable variability in the latter period.
At age 5 between 2016 and 2018, kids’ average HbA1c was 65 mmol/mol, the authors reported. That jumped to 78 mmol/mol between the ages of 15 and 18, decreased to 64 mmol/mol by age 28 and steadied itself between 58 and 63 mmol/mol by age 30. The same discrepancies weren’t observed in adults.
“Within this age range of adolescents and young adults, factors that have been associated with HbA1c levels, such as race/ethnicity and socioeconomic status, appeared balanced between the two time periods,” Foster et al. wrote. “Thus, we do not have an explanation for this increase and it is possible that the finding could reflect a difference in diabetes duration between time periods even though duration was adjusted for analysis or could be due to other unmeasured confounding factors.”
Still, they said, there wasn’t any indication from those data that HbA1c levels in the registry improved as a whole over the study period, in spite of a more than tenfold increase in the use of continuous glucose monitoring (CGM) in children and a 6 percent higher rate of insulin pump use.
HbA1c levels were lower in CGM users than in nonusers, Foster and co-authors wrote. As a treatment, its use rose from 7 percent in 2010-2012 to 30 percent by 2016-2018—something the authors attributed to the ability of parents to monitor CGM data for their kids remotely. There was minimal adoption of other mobile medical applications during the study period, with pump use increasing only modestly in comparison.
“Although use of devices has increased, downloading of device data with retrospective review of the data as part of diabetes self-management has not,” Foster et al. said. “With recent greater emphasis on seamless transmission of data to the cloud and enhancements in reporting and decision-support tools, the integration of device data into self-management can be expected to increase.”
The team also noted a racial disparity when it came to the use of technology and glycemic control. HbA1c levels were markedly higher in black patients than whites or non-Hispanic whites, which could be explained by a higher mean glucose in black patients compared to white patients. Foster and colleagues said other differences might be explained by differing genetics, red blood cell glycation rates and other biologic factors.
The team concluded that glycemic control hadn’t improved overall between 2010 and 2018, “and in fact appears to have worsened, particularly in adolescents.” They called for further research and innovations to improve glucose control in the T1D population.