Trends in Glycemia between 2002 and 2016 among Incident Youth Cohorts Early in the Course of Type 1 Diabetes: The SEARCH for Diabetes in Youth Study

Abstract

Objective: Hyperglycemia early in the course of type 1 diabetes (T1D) may increase the risk of cardiometabolic complications later in life. We tested the hypothesis that there were temporal trends in population-level glycemia and insulin pump use near T1D diagnosis among incident youth cohorts diagnosed between 2002 and 2016.

Methods: Weighted and adjusted regression models were applied to data from the SEARCH for Diabetes in Youth study to analyze trends in hemoglobin A1c (HbA1c), suboptimal glycemia (HbA1c > 9% or not), and insulin pump use among youth with T1D within 30 months of diagnosis. We tested the interaction of year with race and ethnicity, sex, and insulin regimen to assess potential disparities.

Results: Among the 3,956 youth with T1D, there was a small, clinically insignificant reduction in HbA1c between 2002 (7.9% ± 1.5) and 2016 (7.8% ± 2.4) (fully adjusted change by year (-0.013% [95% CI -0.026, -0.0008], p = 0.04). The proportion of youth with suboptimal glycemia increased with each year, but the adjusted odds did not change. Insulin pump use increased more than fivefold. Although interaction effects of time with race and ethnicity, sex, and insulin regimen were not detected, in 2016, suboptimal glycemia was 4.3 and 1.8 times more prevalent among Black and Hispanic than among non-Hispanic White youth, respectively.

Conclusions: There was not a clinically significant population-level improvement in glycemia across incident youth cohorts early in the course of T1D, despite severalfold increases in insulin pump use. Comprehensive clinical interventions to improve glycemia early in the T1D course and address disparities are urgently needed.

Figure 1

Mean hemoglobin A1c across incident youth cohorts with type 1 diabetes, overall and by race and ethnicity subgroup. (a) There was a small but clinically nonsignificant reduction in the fully adjusted overall change in hemoglobin A1c (HbA1c) over time. (b) The interaction of time with race and ethnicity for HbA1c was not statistically significant, but racial and ethnic disparities persisted over time. In particular, mean HbA1c was higher among Black youth than among non-Hispanic White youth in all index years. The Other race and ethnicity subgroup includes youth with an Other, Unknown, Asian or Pacific Islander, or Native American race and a Hispanic ethnicity. Sample sizes for subgroups across index years ranged from n = 40-93 for Black youth, n = 42-117 for Hispanic youth, n = 7-30 for youth with an Other race, and n = 149-475 for non-Hispanic White youth. Abbreviations: Hispa—Hispanic; Other—Other or Unknown; White—non-Hispanic.