Current State of Type 1 Diabetes Treatment in the U.S.: Updated Data From the T1D Exchange Clinic Registry

To examine the overall state of metabolic control and current use of advanced diabetes technologies in the U.S., we report recent data collected on individuals with type 1 diabetes participating in the T1D Exchange clinic registry. Data from 16,061 participants updated between 1 September 2013 and 1 December 2014 were compared with registry enrollment data collected from 1 September 2010 to 1 August 2012. Mean hemoglobin A1c (HbA1c) was assessed by year of age from <4 to >75 years. The overall average HbA1c was 8.2% (66 mmol/mol) at enrollment and 8.4% (68 mmol/mol) at the most recent update. During childhood, mean HbA1c decreased from 8.3% (67 mmol/mol) in 2–4-year-olds to 8.1% (65 mmol/mol) at 7 years of age, followed by an increase to 9.2% (77 mmol/mol) in 19-year-olds. Subsequently, mean HbA1c values decline gradually until ∼30 years of age, plateauing at 7.5–7.8% (58–62 mmol/mol) beyond age 30 until a modest drop in HbA1c below 7.5% (58 mmol/mol) in those 65 years of age. Severe hypoglycemia (SH) and diabetic ketoacidosis (DKA) remain all too common complications of treatment, especially in older (SH) and younger patients (DKA). Insulin pump use increased slightly from enrollment (58–62%), and use of continuous glucose monitoring (CGM) did not change (7%). Although the T1D Exchange registry findings are not population based and could be biased, it is clear that there remains considerable room for improving outcomes of treatment of type 1 diabetes across all age-groups. Barriers to more effective use of current treatments need to be addressed and new therapies are needed to achieve optimal metabolic control in people with type 1 diabetes.

[1]  Matthew D. Davis,et al.  Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus. , 2002, JAMA.

[2]  J. McGill,et al.  Evidence of a Strong Association Between Frequency of Self-Monitoring of Blood Glucose and Hemoglobin A1c Levels in T1D Exchange Clinic Registry Participants , 2013, Diabetes Care.

[3]  J. Stockman.  The Burden of Diabetes Mellitus Among US Youth: Prevalence Estimates From the SEARCH for Diabetes in Youth Study , 2008 .

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

[5]  David M. Maahs,et al.  Real-Time Continuous Glucose Monitoring Among Participants in the T1D Exchange Clinic Registry , 2014, Diabetes Care.

[6]  R. Beck,et al.  Insulin pump use in young children in the T1D Exchange clinic registry is associated with lower hemoglobin A1c levels than injection therapy , 2014, Pediatric diabetes.

[7]  Michael O'Grady,et al.  Continuous glucose monitoring and intensive treatment of type 1 diabetes. , 2008, The New England journal of medicine.

[8]  R. Beck,et al.  Most Youth With Type 1 Diabetes in the T1D Exchange Clinic Registry Do Not Meet American Diabetes Association or International Society for Pediatric and Adolescent Diabetes Clinical Guidelines , 2013, Diabetes Care.

[9]  Diabetes Control.  Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group. , 1994, The Journal of pediatrics.

[10]  11. Children and Adolescents , 2015, Diabetes Care.

[11]  H. Parving,et al.  Effect of insulin analogues on risk of severe hypoglycaemia in patients with type 1 diabetes prone to recurrent severe hypoglycaemia (HypoAna trial): a prospective, randomised, open-label, blinded-endpoint crossover trial. , 2014, The lancet. Diabetes & endocrinology.

[12]  R. Beck,et al.  Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry. , 2013, The Journal of clinical endocrinology and metabolism.

[13]  B. Zinman,et al.  Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality. , 2015, JAMA.

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

[15]  S. Bailey,et al.  Children and adolescents. , 2004, Criminal behaviour and mental health : CBMH.

[16]  George Dailey,et al.  Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes. , 2010, The New England journal of medicine.

[17]  M. Rewers,et al.  Assessment and monitoring of glycemic control in children and adolescents with diabetes , 2007, Pediatric diabetes.

[18]  R. Beck,et al.  A contrast between children and adolescents with excellent and poor control: the T1D exchange clinic registry experience , 2014, Pediatric diabetes.

[19]  H. Grossniklaus.  Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus. Writing Team ∗ for the Diabetes Control and Complications Trial/Epidemiol-ogy of Diabetes Interventions and Complications Research Group. JAMA 2002;287:2563-2569. , 2002 .

[20]  D. Harlan,et al.  Differences in the Management of Type 1 Diabetes Among Adults Under Excellent Control Compared With Those Under Poor Control in the T1D Exchange Clinic Registry , 2013, Diabetes Care.

[21]  D. Nathan,et al.  The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study at 30 Years: Overview , 2013, Diabetes Care.

[22]  R. Beck.  Effectiveness of Continuous Glucose Monitoring in a Clinical Care Environment , 2009, Diabetes Care.

[23]  P. Royle,et al.  The use of metformin in type 1 diabetes: a systematic review of efficacy , 2010, Diabetologia.

[24]  R. Beck,et al.  Severe hypoglycemia and diabetic ketoacidosis among youth with type 1 diabetes in the T1D Exchange clinic registry , 2013, Pediatric diabetes.