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

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.

[1]  O. Kordonouri,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 , 2017, JAMA.

[2]  S. Wild,et al.  Glycaemic control of Type 1 diabetes in clinical practice early in the 21st century: an international comparison , 2015, Diabetic medicine : a journal of the British Diabetic Association.

[3]  Kellee M Miller,et al.  The T1D Exchange clinic registry. , 2012, The Journal of clinical endocrinology and metabolism.

[4]  S. Genuth,et al.  The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. , 1993, The New England journal of medicine.

[5]  R. Beck,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 , 2014, Diabetologia.

[6]  Sofia Dahlqvist,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 , 2017, JAMA.

[7]  J. Todd,et al.  Interleukin-2 Therapy of Autoimmunity in Diabetes (ITAD): a phase 2, multicentre, double-blind, randomized, placebo-controlled trial , 2020, Wellcome open research.

[8]  D. Maahs,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 , 2018, Diabetes Care.

[9]  R. Beck,et al.  Severe hypoglycemia rates are not associated with HbA1c: a cross‐sectional analysis of 3 contemporary pediatric diabetes registry databases , 2017, Pediatric diabetes.

[10]  D. Maahs,et al.  Prevalence of Celiac Disease in 52,721 Youth With Type 1 Diabetes: International Comparison Across Three Continents , 2017, Diabetes Care.

[11]  David M Maahs,et al.  Current State of Type 1 Diabetes Treatment in the U.S.: Updated Data From the T1D Exchange Clinic Registry , 2015, Diabetes Care.

[12]  B. Anderson,et al.  Text Message Intervention for Teens with Type 1 Diabetes Preserves HbA1c: Results of a Randomized Controlled Trial. , 2020, Diabetes technology & therapeutics.

[13]  R. Beck,et al.  Racial-Ethnic Disparities in Management and Outcomes Among Children With Type 1 Diabetes , 2015, Pediatrics.

[14]  A. Rogers,et al.  A Facilitated Web-Based Self-Management Tool for People With Type 1 Diabetes Using an Insulin Pump: Intervention Development Using the Behavior Change Wheel and Theoretical Domains Framework , 2020, Journal of medical Internet research.

[15]  R. Beck,et al.  Obesity in Youth with Type 1 Diabetes in Germany, Austria, and the United States. , 2015, The Journal of pediatrics.

[16]  Howard Wolpert,et al.  Effect of Continuous Glucose Monitoring on Glycemic Control in Adults With Type 1 Diabetes Using Insulin Injections: The DIAMOND Randomized Clinical Trial , 2017, JAMA.

[17]  D. Maahs,et al.  International Comparison of Smoking and Metabolic Control in Patients With Type 1 Diabetes , 2016, Diabetes Care.

[18]  R. Beck,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 , 2015, Diabetes Care.

[19]  D. Maahs,et al.  Continuous glucose monitoring and glycemic control among youth with type 1 diabetes: International comparison from the T1D Exchange and DPV Initiative , 2018, Pediatric diabetes.

[20]  Ji H Cj Chun,et al.  Optimizing Diabetes Care With the Standardized Continuous Glucose Monitoring Report , 2020, Clinical Diabetes.

[21]  R. Beck,et al.  Risk Factors Associated With Severe Hypoglycemia in Older Adults With Type 1 Diabetes , 2015, Diabetes Care.

[22]  J. Versloot,et al.  Using Person-Reported Outcomes (PROs) to Motivate Young People with Diabetes , 2020, Current Diabetes Reports.

[23]  R. Beck,et al.  Racial Differences in the Relationship of Glucose Concentrations and Hemoglobin A1c Levels. , 2017, Annals of internal medicine.

[24]  D. Maahs,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 , 2017, Diabetes Care.