T1D Trends in the US: updates on the management of type 1 diabetes

T1D Trends in the US: updates on the management of type 1 diabetes

A recently published  report from the Type 1 Diabetes (T1D) Exchange clinical registry  provides a snapshot on the current trends of T1D care and outcomes as well as changes over time.

With data collected from over 22 000 participants with T1D aged 1 to 93 years old, this report provides important information on how T1D is managed in the US, below are the highlights.

Blood glucose control trends

First, they found that the majority of participants were unable to reach the recommended glycated hemoglobin A1c (HbA1c) level (reflecting diabetes control and ideally equal to or less than 7.5%).

They also found that average HbA1c was generally higher in 2016-2018, when compared to 2010-2012. However, it seemed to remain relatively steady at around 7.5% to 7.9% in participants older than 30 years.

As for short term complications they also found that:

  1. Overall, 5-10% of participants had at least 1 episode of severe hypoglycemia (defined as loss of consciousness or seizure) between 2016 and 2018.
  2. 1-4% participants reported at least one episode of DKA (diabetes ketoacidosis or severe hyperglycemia) that required an overnight hospitalization

Technology use trends

An expected trend was the increased adoption of newer technologies (insulin pumps, continuous glucose monitors (CGM)) compared to their 2010-2012 report.

An increase in insulin pump use from 57% in 2010-2012 to 63% in 2016-2018, while modest, is a reflection of the growing inclination for newer therapies.

They also found that CGM use among the participants has steadily increased over the past years going from 6% use in 2011 to 38% in 2018.

Technology use and its effect on blood glucose control

CGM’s increasing popularity was mostly striking in children, growing from 4% to 51% in children younger than 6 and from 3% to 37% in children aged 6-12.

With the increased interest and use of newer technologies, this study also evaluated the effect of these tools on the quality of the blood glucose control.

They found that overall, HbA1c was lower when participants used newer technology as summarized in the graph below.

Highest average HbA1c values were consistently reported in the 13-26 year old group, across technologies.

They also found that participants using an insulin pump (as well as CGM users) were less likely to report experiencing a Diabetic ketoacidosis event or a severe hypoglycemia episode than participants using injections.

Use of registries and T1D research

This large study was possible thanks to the American Type 1 Diabetes (T1D) Exchange clinical registry launched in 2010. This registry, the first large database for type 1 diabetes, allowed for many studies to be conducted to improve care and inspired our Quebec-based registry, BETTER, that we hope will participate in making current T1D practices more efficient for the wellbeing of all those who live with T1D.

Reference:

Foster NC, Beck RW, Miller KM, et al. State of type 1 diabetes management and outcomes from the t1d exchange in 2016-2018. Diabetes technology & therapeutics. 2019;21(2):66-72. doi:10.1089/dia.2018.0384