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

Abstract

Objective: To assess the proportion of youth with type 1 diabetes under the care of pediatric endocrinologists in the United States meeting targets for HbA1c, blood pressure (BP), BMI, and lipids.

Research design and methods: Data were evaluated for 13,316 participants in the T1D Exchange clinic registry younger than 20 years old with type 1 diabetes for ≥1 year.

Results: American Diabetes Association HbA1c targets of <8.5% for those younger than 6 years, <8.0% for those 6 to younger than 13 years old, and <7.5% for those 13 to younger than 20 years old were met by 64, 43, and 21% of participants, respectively. The majority met targets for BP and lipids, and two-thirds met the BMI goal of <85th percentile.

Conclusions: Most children with type 1 diabetes have HbA1c values above target levels. Achieving American Diabetes Association goals remains a significant challenge for the majority of youth in the T1D Exchange registry.

Figure 1

A: Proportion of participants meeting HbA_1c targets (N = 13,226). ADA (black bars): <8.5% for those 1 to younger than 6 years of age, <8.0% for those 6 to younger than 13 years of age, and <7.5% for those 13 to younger than 20 years of age. ISPAD (striped bars): <7.5%. B: Proportion of participants meeting BP target (N = 12,664) <90th percentile for age, sex, and height. C: Proportion of participants meeting BMI target (N = 13,045) <85th percentile for age and sex. BMI percentile was not calculated for those younger than 2 years of age. D: Proportion of participants meeting fasting LDL target (N = 3,010) <100 mg/dL (<2.6 mmol/L). E: Proportion of participants meeting HDL target (N = 8,938). ADA (black bars): >35 mg/dL; ISPAD (striped bars): >1.1 mmol/L. F: Proportion of participants meeting triglycerides target (N = 2,454) <150 mg/dL (<1.7 mmol/L).