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A Large Study Finds Most People with Type 1 Diabetes Don’t Meet HbA1c Goals

-Craig Idlebrook

A large-scale study on thousands of people with type 1 diabetes shows that mean HbA1c levels have stubbornly stayed the same or risen since 2012, despite increased use of diabetes technology. However, a deeper read into this study of T1D Exchange Registry participants illuminates a number of important trends, both good and bad, in blood sugar management among people with type 1 diabetes in the United States.

For the study, a team of researchers with the Jaeb Center for Health Research and several institutions compared health data that participants from the T1D Exchange Clinic Registry during two time periods – 2010-2012 and 2016-2018.

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Here are nine important takeaways from the study:

-This was a large-scale study, involving over 25 thousand participants between 2010 and 2012 and over 22 thousand participants between 2016 and 2018. It also took place in 81 endocrinology practices across 35 states.

-Only 17 percent of children with type 1 diabetes and 21 percent of adults with type 1 diabetes met the American Diabetes Association’s goals for HbA1c levels.

-Teens and young adults with type 1 diabetes were the ones mainly responsible for pushing the mean HbA1c results from 7.8 percent in 2010 and 2012 to 8.4 percent during 2016 and 2018.

-While insulin pump use rose modestly during this time, CGM use was the fastest climbing technology, with an adoption rate that spiked from 7 percent to 30 percent of participants.

-The future of type 1 diabetes will likely be tech-driven, as children saw the biggest gains in adoption rates of diabetes technology. In one eye-popping example, CGM use among children under the age of six went from just 4 percent by 2012 to a whopping 51 percent by 2018. Sizeable gains were also made in insulin pump adoption among children, too.  

-While technology didn’t lower overall HbA1c rates among the population studied, Jaeb researcher Nicole Foster pointed out that technology adoption rates still have a lot of room to grow. Also, it should be noted that a semi-automated insulin pump system (the Medtronic 670G) was still just entering the market by the end of the study. A future study like this might show technology having a bigger impact on HbA1c rates among the average type 1 diabetes population than this one.

-Very few people with type 1 diabetes are using other drug therapies than insulin to lower blood glucose. For example, only 6 percent of participants less than 26 years of age used metformin during the study.

-Blood ketone testing isn’t happening that often. The researchers found that adults with type 1 diabetes are not tested for ketones nearly as much as children with type 1 diabetes. Also, only 20 percent of the population studied had a blood ketone meter.

-While this was a very large study, the researchers were the first to admit that there were lacking data from certain important populations, including the underinsured or uninsured and from those who don’t see an endocrinologist for diabetes care. The researchers suggested that HbA1c levels are actually likely to be worse if you factor those populations into the data mix.

In other words, diabetes researchers and diabetes technology engineers have their work cut out for them if the U.S. population with type 1 diabetes is going to meet ADA guidelines for HbA1c levels anytime soon.

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