State of Type 1 Diabetes Management and Outcomes from the T1D Exchange in 2016–2018
This article has been corrected.
VIEW CORRECTIONPublication: Diabetes Technology & Therapeutics
Volume 21, Issue Number 2
Abstract
Objective: 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.
Research Design and Methods: 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.
Results: Mean HbA1c in 2016–2018 increased from 65 mmol/mol at the age of 5 years to 78 mmol/mol between ages 15 and 18, with a decrease to 64 mmol/mol by age 28 and 58–63 mmol/mol beyond age 30. The American Diabetes Association (ADA) HbA1c goal of <58 mmol/mol for youth was achieved by only 17% and the goal of <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.
Conclusions: 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.
Get full access to this article
View all available purchase options and get full access to this article.
References
1.Beck RW, Tamborlane WV, Bergenstal RM, et al.: The T1D Exchange Clinic Registry. J Clin Endocrinol Metab 2012;97:4383–4389.
2.Miller KM, Foster NC, Beck RW, et al: Current state of type 1 diabetes treatment in the U.S.: updated data from the T1D Exchange clinic registry. Diabetes Care 2015;38:971–978.
3.Charalampopoulos D, Hermann JM, Svensson J, et al.: Exploring variation in glycemic control across and within eight high-income countries: a cross-sectional analysis of 64,666 children and adolescents with type 1 diabetes. Diabetes Care 2018;41:1180–1187.
4.Craig ME, Prinz N, Boyle CT, et al.: Prevalence of celiac disease in 52,721 youth with type 1 diabetes: international comparison across three continents. Diabetes Care 2017;40:1034–1040.
5.DeSalvo DJ, Miller KM, Hermann JM, et al.: Continuous glucose monitoring and glycemic control among youth with type 1 diabetes: international comparison from the T1D Exchange and DPV Initiative. Pediatr Diabetes 2018;19:1271–1275.
6.DuBose SN, Hermann JM, Tamborlane WV, et al.: Obesity in youth with type 1 diabetes in Germany, Austria, and the United States. J Pediatr 2015;167:627–632.e624.
7.Haynes A, Hermann JM, Miller KM, et al.: Severe hypoglycemia rates are not associated with HbA1c: a cross-sectional analysis of 3 contemporary pediatric diabetes registry databases. Pediatr Diabetes 2017;18:643–650.
8.Hofer SE, Miller K, Hermann JM, et al.: International comparison of smoking and metabolic control in patients with type 1 diabetes. Diabetes Care 2016;39:e177–e178.
9.Lyons SK, Hermann JM, Miller KM, et al.: Use of adjuvant pharmacotherapy in type 1 diabetes: international comparison of 49,996 individuals in the prospective diabetes follow-up and T1D Exchange Registries. Diabetes Care 2017;40:e139–e140.
10.Maahs DM, Hermann JM, DuBose SN, et al.: Contrasting the clinical care and outcomes of 2,622 children with type 1 diabetes less than 6 years of age in the United States T1D Exchange and German/Austrian DPV registries. Diabetologia 2014;57:1578–1585.
11.Maahs DM, Hermann JM, Holman N, et al.: Rates of diabetic ketoacidosis: international comparison with 49,859 pediatric patients with type 1 diabetes from England, Wales, the U.S., Austria, and Germany. Diabetes Care 2015;38:1876–1882.
12.McKnight JA, Wild SH, Lamb MJ, et al.: Glycaemic control of type 1 diabetes in clinical practice early in the 21st century: an international comparison. Diabet Med 2015;32:1036–1050.
13.Willi SM, Miller KM, Dimeglio LA, et al.: Racial-ethnic disparities in management and outcomes among children with type 1 diabetes. Pediatrics 2015;135:424–434.
14.Bergenstal RM, Gal RL, Connor CG, et al.: Racial differences in the relationship of glucose concentrations and hemoglobin A1c levels. Ann Intern Med 2017;167:95–102.
15.Weinstock RS, DuBose SN, Bergenstal RM, et al.: Risk factors associated with severe hypoglycemia in older adults with type 1 diabetes. Diabetes Care 2016;39:603–610.
16.The Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977–986.
17.Beck RW, Riddlesworth T, Ruedy K, et al.: Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: the DIAMOND randomized clinical trial. JAMA 2017;317:371–378.
18.Lind M, Polonsky W, Hirsch IB, et al.: Continuous glucose monitoring vs conventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections: the GOLD randomized clinical trial. JAMA 2017;317:379–387.
19.Karges B, Schwandt A, Heidtmann B, et al.: Association of insulin pump therapy vs insulin injection therapy with severe hypoglycemia, ketoacidosis, and glycemic control among children, adolescents, and young adults with type 1 diabetes. JAMA 2017;318:1358–1366.
Information & Authors
Information
Published In
Diabetes Technology & Therapeutics
Volume 21 • Issue Number 2 • February 2019
Pages: 66 - 72
PubMed: 30657336
Copyright
Copyright 2019, Mary Ann Liebert, Inc., publishers.
History
Published in print: February 2019
Published online: 1 February 2019
Published ahead of print: 18 January 2019
Topics
Authors
Authors' Contributions
N.C.F. researched data, contributed to data interpretation, and writing of the article. R.W.B. researched data, contributed to data interpretation, and writing of the article. K.M.M. researched data and contributed to data interpretation. M.A.C. researched data and contributed to data interpretation. M.R.R. researched data and contributed to data interpretation. L.A.D. researched data and contributed to data interpretation. D.M.M. researched data and contributed to data interpretation. W.V.T. researched data and contributed to data interpretation. R.B. researched data and contributed to data interpretation. E.S. researched data and contributed to data interpretation. B.A.O. researched data and contributed to data interpretation. S.K.G. researched data and contributed to data interpretation. N.C.F. is the guarantor of this work, and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis.
Author Disclosure Statement
No competing financial interests exist.
Metrics & Citations
Metrics
Citations
Export Citation
Export citation
Select the format you want to export the citations of this publication.
View Options
Get Access
Access content
To read the fulltext, please use one of the options below to sign in or purchase access.⚠ Society Access
If you are a member of a society that has access to this content please log in via your society website and then return to this publication.