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. 2019 Feb;21(2):66-72.
doi: 10.1089/dia.2018.0384. Epub 2019 Jan 18.

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

Nicole C Foster  1 , Roy W Beck  1 , Kellee M Miller  1 , Mark A Clements  2 , Michael R Rickels  3 , Linda A DiMeglio  4 , David M Maahs  5 , William V Tamborlane  6 , Richard Bergenstal  7 , Elizabeth Smith  1 , Beth A Olson  7 , Satish K Garg  8
Affiliations

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

Nicole C Foster et al. Diabetes Technol Ther. 2019 Feb.

Erratum in

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.

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Conflict of interest statement

No competing financial interests exist.

Figures

<b>FIG. 1.</b>
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.
<b>FIG. 2.</b>
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.
<b>FIG. 3.</b>
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.
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