Minority of patients with type 1 diabetes achieve ADA goals for glycemic control, study finds

Despite increasing adoption of insulin pumps and continuous glucose monitors, control of HbA1c hasn't necessarily improved, the authors noted.

Only a minority of people with type 1 diabetes in the United States achieve American Diabetes Association (ADA) goals for HbA1c levels, a study found.

Researchers examined data from the T1D Exchange registry on diabetes management and outcomes from 22,697 people ages 1 to 93 years in 2016-2018 and compared them with data collected in 2010-2012 for 25,529 people. Results were published Feb. 1 by Diabetes Technology & Therapeutics.

Mean HbA1c levels in 2016-2018 increased from 8.1% at the age of 5 years to 9.3% between ages 15 and 18 years, with a decrease to 8.0% by age 28 years and 7.5% to 7.9% beyond age 30 years. The ADA's HbA1c goal of less than 7.5% for youth was achieved by only 17% of people, while the goal of less than 7.0% for adults was achieved by only 21% of people.

Among 9,657 participants who had data available in both 2010-2012 and 2016-2018 and at least a three-year history of diabetes in 2010-2012, mean HbA1c level was higher in 2016-2018 than in 2010-2012. The adjusted mean HbA1c level was 7.8% in 2010-2012 and 8.4% in 2016-2018 (P<0.001 adjusted for age, diabetes duration, self-monitoring of blood glucose level, and use of a continuous glucose monitor). The increase over time in HbA1c was seen mostly in adolescents and young adults, the authors wrote.

Insulin pump use increased from 57% in 2010-2012 to 63% in 2016-2018, while continuous glucose monitoring increased from 7% in 2010-2012 to 30% in 2016-2018. For both of these variables, the largest increases were seen among children. HbA1c levels were lower in patients who used monitors than in nonusers. Across all age groups, there were racial and ethnic differences in frequency of insulin pump use and continuous glucose monitoring.

The authors noted no indication that HbA1c levels had improved over a five-year period, despite an increase in use of technology. “Although use of devices has increased, downloading of device data with retrospective review of the data as part of diabetes self-management has not,” the authors wrote. “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.” They called for further research into ways to improve glucose control and eliminate disparities.