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

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.

Keywords: Continuous glucose monitor use; Insulin pump use.; T1D Exchange registry.

Conflict of interest statement

No competing financial interests exist.

Figures

FIG. 1.

(A) CGM use over time. (B) CGM use in 2010–2012 versus 2016–2018. Solid white represents 2010–2012 (7% use of CGM overall). Solid black represents 2016–2018 (30% use of CGM overall). CGM, continuous glucose monitoring.

FIG. 2.

Average HbA1c by year of age: 2010–2012 versus 2016–2018. Orange line represents 2010–2012 cohort, and blue line represents 2016–2018 cohort. Participants must be contained in both cohorts with at least a 3-year duration for the 2010–2012 collection. * ≥80 years old are pooled.

FIG. 3.

Mean HbA1c by technology use in 2016–2018. Solid black represents injection only. Horizontal stripes represent pump only. Solid white represents injection+CGM. Diagonal stripes represent pump+CGM.