Achieving Optimal Blood Sugar Control: A Real Challenge for People Living with Type 1 Diabetes

A study that was presented at the September 2019 EASD Annual Meeting showed how difficult it is to achieve optimal blood sugar levels for those living with type 1 diabetes. As part of this study, data was collected in 17 countries in Western and Eastern Europe, Latin America, Asia and the Middle East (North America and Africa weren’t included) from 4,000 adults with type 1 diabetes aged 26 and over. 

The results

Although the results varied significantly from one region to another, one trend emerged: the difficulty associated with managing blood sugar levels. 

  • Hemoglobin A1c (also called “A1c,” which reflects your average blood sugars over the past three months): Only 20% of participants said their A1c was below 7%, which is the recommended threshold for most people with diabetes. In fact, more than 40% had an A1c higher than 8%, and 20% had an A1c higher than 9%.
  • Severe hypoglycemia: Approximately 12% of participants said they had experienced severe hypoglycemia (which either involves loss of consciousness or requires another person’s intervention to be treated) in the past three months.
  • Ketoacidosis (severe hyperglycemia that requires hospitalization and intravenous insulin infusion): Around 4% of participants had experienced diabetic ketoacidosis in the past six months.

With such numbers, there’s no denying that achieving target blood sugar levels represents a challenge for people living with type 1 diabetes. 

Tough crowd for technology use

Only 20% of participants used an insulin pump

Among those who used injections, about 10% used intermediate-acting insulin (e.g., NPH). This number is surprisingly high since this type of insulin, which is active between 14 and 16 hours a day, tends to be replaced with new longer-duration types of insulins that can cover a whole day’s needs and reduce the risk of hypoglycemia.

The study also revealed that 43% of participants didn’t adjust their own insulin dosage and, as a result, relied on their doctor or healthcare team to make these adjustments. It’s highly recommended that people living with type 1 diabetes receive training for adjusting their own insulin dosages.

Among all the participants, 23% used a continuous glucose monitoring (CGM) system. Once again, the results vary greatly from region to another: 46.4% in Western Europe, 2.5% in the Middle East, 4.7% in Eastern Europe, 21.1% in Latin America and 25.5% in Asia.

The study didn’t include the United States, but data from the US-based T1D Exchange Registry show similar results. 

What about Quebec?

There wasn’t any registry of people living with type 1 diabetes in Quebec, so there’s no data to compare these results to.

That’s why we’ve created the first registry in Quebec where people living with type 1 diabetes can sign up. The BETTER registry already includes more than 700 people!

Go to type1better.com to register.


  • Renard, E., Pozzilli, P., Wilmot, E.G., Peters, A., Bosnyak, Z., Castro, R., Lauand, F., Pilorget, V., Brette, S., Ikegami, H., Kesavadev, J., Vianna, A.G. (2019). Suboptimal glycaemic control globally in all age groups of adults with type 1 diabetes: results of a multinational, observational study (SAGE), Abstract OP 03, 55th EASD Annual Meeting, Presented September 17, 2019. 
  • Foster, N., Beck, R.W., Miller, K.M., Clements, M.A., Rickels, M.R., DiMeglio, L.A., Maahs, D.M., Tamborlane, W.V., Bergenstal, R. Smith, E., Olson, B.A., Garg, S.K. (2019). State of Type 1 Diabetes Management and Outcomes from the T1D Exchange in 2016–2018. Diabetes Technology & Therapeutics. doi:10.1089/dia.2018.0384. 

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