Impact of Target HbA1c Change in Pediatric Participants in the T1D Exchange Clinic Registry

Abstract

In 2014, the American Diabetes Association lowered its recommended HbA1c target for children with type 1 diabetes (T1D) from <8.5% for <6 years, <8.0% for 6-<13 years, and <7.5 for 13-<18 years to <7.5% for all ages. To determine if HbA1c changed in response, we compared two cross-sectional cohorts of T1D participants in the United States aged <18 years with T1D duration ≥1 year from the T1D Exchange Clinic Registry. The first cohort (PRE) were participants who enrolled between 2010 and 2012 (n=11,788). The second cohort (POST) were participants with an update between 2016 and 2017 (n=9,234). For each age group, mean HbA1c was compared between the cohorts using a linear regression model adjusted for age, T1D duration, and socioeconomic status (SES). A comparison of the cohorts can be found in Table 1. Demographic and SES characteristics were similar between the cohorts. More participants in the POST cohort were using insulin pumps and CGMs. Mean HbA1c was similar between the two cohorts for those <6 years, though more participants in the POST cohort met the current HbA1c target. For the 6-<13 and 13-<18 age groups, those in the POST cohort had higher mean HbA1c, with fewer meeting the current HbA1c target (p<0.01). Thus, despite the lowering of HbA1c targets, glycemic control remains suboptimal in this population. Disclosure J. Wood: None. C. Boyle: None. M. Quinn: None. J.C. Wong: Research Support; Self; Dexcom, Inc.. Other Relationship; Self; Tidepool Project. M.J. Haller: None. B.A. Nelson: Speaker's Bureau; Self; Dexcom, Inc.. M.J. Haller: None. D. Schatz: None. W.V. Tamborlane: Consultant; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Medtronic MiniMed, Inc., Novo Nordisk Inc., Sanofi, Takeda Pharmaceuticals U.S.A., Inc.. L. Fox: None. P. Prahalad: None. S. Corathers: None. D.M. Maahs: Advisory Panel; Self; Insulet Corporation. Consultant; Self; Abbott. Research Support; Self; Medtronic, Bigfoot Biomedical, Dexcom, Inc., Insulet Corporation, Roche Diabetes Care Health and Digital Solutions. G.T. Alonso: None. D.J. DeSalvo: Consultant; Self; Dexcom, Inc.. Speaker's Bureau; Self; Insulet Corporation. R. Wadwa: Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; Dexcom, Inc., Xeris Pharmaceuticals, Inc., Novo Nordisk Inc., MannKind Corporation, Bigfoot Biomedical. L. DiMeglio: Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; Dexcom, Inc., Medtronic, Sanofi, Caladrius Biosciences, Inc., Janssen Research & Development, Xeris Pharmaceuticals, Inc., Sanofi.

Closed loop control in adolescents and children during winter sports: Use of the Tandem Control‐IQ AP system

“…These concerns continue to this day with an average hemoglobin A1C (HbA1c) >8% in children 8 and above, reaching 9% by 16 years of age . Less than 20% of youth achieve HbA1c levels in target range per current American Diabetes Association guidelines (HbA1c ≤7.5%) . In addition, about 10% suffer from one or more episodes of diabetes ketoacidosis (DKA) per year and 6% have one or more severe hypoglycemic events per year …”

“…3 Less than 20% of youth achieve HbA1c levels in target range per current American Diabetes Association guidelines (HbA1c ≤7.5%) . 4,5 In addition, about 10% suffer from one or more episodes of diabetes ketoacidosis (DKA) per year and 6% have one or more severe hypoglycemic events per year. 6 Automated glucose control is a promising approach to regulate glucose and decrease the burden of diabetes care for the pediatric patients and their parents.…”