The Transatlantic HbA_1c gap: differences in glycaemic control across the lifespan between people included in the US T1D Exchange Registry and those included in the German/Austrian DPV registry

Abstract

Aim To compare HbA 1c levels across the lifespan in people with type 1 diabetes in the USA with those in Germany/ Austria, and to examine potential differences in HbA 1c levels between sexes, insulin delivery methods and minority status.Methods Data were extracted from the US T1D Exchange Registry (n=18 381 participants from 73 sites) and from the German/Austrian Prospective Diabetes Follow-up Registry, the DPV (n=32 643 participants from 362 sites). Mean HbA 1c was calculated for each year of age for individuals aged ≤25 years, and at 2-year age intervals for individuals aged >25 years. Curves for mean HbA 1c by age were estimated using locally weighted scatterplot smoothing. HbA 1c differences between registries, sexes, insulin delivery methods, and minority status were assessed by age group using multiple linear regression. ResultsIn both registries, mean HbA 1c increased by~11 mmol/mol (1.0%) between the ages of 9 and 18 years, although at quite different absolute levels: from 66 mmol/mol (8.2%) to 77 mmol/mol (9.2%) in the T1D Exchange Registry, and from 56 mmol/mol (7.3%) to 66 mmol/mol (8.2%) in the DPV. Sex differences were observed in the DPV only. In the T1D Exchange Registry, injection users had higher mean HbA 1c than pump users across the lifespan, whereas in the DPV higher HbA 1c levels in injection users were observed in the age groups 6 to <12 years, 12 to <18 years, and 30 to <50 years (P < 0.001). Minority status was significantly associated with higher HbA 1c in most age groups in both registries. Conclusions Significant differences in HbA 1c were noted between the USA and Germany/Austria, with disparities more pronounced in early childhood through to young adulthood. Further studies should identify causes for these disparities.

Comparison of the effects of lockdown due to COVID-19 on glucose patterns among children, adolescents, and adults with type 1 diabetes: CGM study

“…This is particularly true for the subgroup of teenagers whose mean glycated hemoglobin levels are better than those reported in the literature and consistent with those of motivated patients. 25 Therefore, those results may not be extended to all patients with T1D, whose glucose changes during lockdown should be addressed in targeted studies. Additionally, we did not investigate the food choices with structured interview, and we did not consider the socioeconomic status of the patients, which may have a relevance in glucose control.…”

“…The mean insulin dose/kg body weight/ day was slightly higher during lockdown than before lockdown (0.55±0.18 U/kg/day vs 0.56±0.18 U/kg/day, p=0.015). Considering the recently published data from the T1D exchange study, 25 showing that glycemic control of people aged 18-25 are worse than children and older people (≥26 years of age), we performed a separate analysis of CGM metrics in patients aged 18.0-25.9 years old (n=10). In this group of patients, prelockdown TIR was significantly lower than TIR during lockdown (median 65.9%, IQR 44.7-76.1 vs median 68.9%, IQR 53.3-78.5; p=0.027), whereas SDglu was significantly lower during lockdown (prelockdown median 56.0%, IQR 48.6-73.6 vs median during lockdown 49.8, IQR 46.0-71.2; p=0.005).…”

Outcomes of monthly video consultations as an add‐on to regular care for children with type 1 diabetes: A 6‐month quasi‐randomized clinical trial followed by an extension phase

“…Effect of video consultation over time on HbA1c the US achieved the American Diabetes Association goals for HbA1c 24. Despite the advancements of new technologies, most patients have great difficulty in downloading their device data, in retrospectively reviewing their device data, and in adjusting their insulin therapy as part of diabetes self-management 25.…”

Charakteristika von Diabetespatienten mit und ohne Pflegebedürftigkeit

“…Neben einer kleinen Gruppe von Kindern mit T1DM sind im Erwachsenenalter sowohl Menschen mit T2-als auch mit T1DM betroffen. Medizinische Besonderheiten geriatrischer Menschen mit Diabetes wurden anhand der Daten des DPV-Registers bereits mehrfach dargestellt [7][8][9].…”