Aurora, CO—Surprisingly few young adults and teenagers with type 1 diabetes (T1D) achieve target levels of hemoglobin A1c, despite the availability of improved medications, a new study finds.

In fact, the report in Diabetes Technology & Therapeutics notes that HbA1c increased in youths in 2016–2018 compared with 2010–2012.

University of Colorado Denver–led researchers and their colleagues derived data for the first 5-year study of outcomes from the T1D Exchange registry from the Helmsley Charitable Trust.

“Despite the availability of newer insulin analogs and increased use of insulin pumps and CGMs in the U.S., the mean A1c levels for patients with type 1 diabetes have increased in the past 5 years and only 1 out 5 patients reach ADA target A1c levels,” explained coauthor Satish Garg, MD, professor of Medicine and Pediatrics at the University of Colorado Denver, who also is editor-in-chief of the journal. “Above all these data represent 30,000 patients followed at the leading centers in the U.S.”

To reach those conclusions, researchers collected data on diabetes management and outcomes from 22,697 registry participants, ages 1 to 93 years, between 2016 and 2018 and compared them with data collected in 2010–2012 for 25,529 registry participants.

Results indicate an increase in 2016–2018 from 65 mmol/mol at the age of 5 years to 78 mmol/mol between ages 15 and 18 years, with a decrease to 64 mmol/mol by age 28 and 58–63 mmol/mol beyond age 30.

The study authors point out that the American Diabetes Association (ADA) HbA1c goal of less than 58 mmol/mol for youth was achieved by only 17% and the goal of less than 53 mmol/mol for adults by only 21%.

The study found that, overall, mean HbA1c levels changed little between 2010–2012 and 2016–2018. That was not the case, however, in adolescents, who had a higher mean HbA1c in 2016–2018.

Over the time period, insulin-pump use increased from 57% to 63%, and continuous glucose monitoring (CGM) increased from 7% to 30%. The study noted that CGM usage rose more than 10-fold in children younger than 12 years and that HbA1c levels were lower in CGM users than in nonusers.

Adults 50 years and older had the greatest problems with severe hypoglycemia, while diabetic ketoacidosis was most common in adolescents and young adults.
“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,” the study authors conclude.

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