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      Factors Associated With Achieving Target A1C in Children and Adolescents With Type 1 Diabetes: Findings From the T1D Exchange Quality Improvement Collaborative

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          Abstract

          The optimal care of type 1 diabetes involves consistent glycemic management to avoid short- and long-term complications. However, despite advancements in diabetes technology and standards, achieving adequate glycemic levels in children and adolescents remains a challenge. This study aimed to identify factors associated with achieving the recommended A1C target of <7% from the United States–based multicenter T1D Exchange Quality Improvement Collaborative cohort, including 25,383 children and adolescents living with type 1 diabetes.

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          State of Type 1 Diabetes Management and Outcomes from the T1D Exchange in 2016–2018

          Nicole C Foster, Roy Beck, Kellee Miller … (2019)
          To provide a snapshot of the profile of adults and youth with type 1 diabetes (T1D) in the United States and assessment of longitudinal changes in T1D management and clinical outcomes in the T1D Exchange registry.
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            Current state of type 1 diabetes treatment in the U.S.: updated data from the T1D Exchange clinic registry.

            Kellee Miller, Nicole C Foster, Roy Beck … (2015)
            To examine the overall state of metabolic control and current use of advanced diabetes technologies in the U.S., we report recent data collected on individuals with type 1 diabetes participating in the T1D Exchange clinic registry. Data from 16,061 participants updated between 1 September 2013 and 1 December 2014 were compared with registry enrollment data collected from 1 September 2010 to 1 August 2012. Mean hemoglobin A1c (HbA1c) was assessed by year of age from 75 years. The overall average HbA1c was 8.2% (66 mmol/mol) at enrollment and 8.4% (68 mmol/mol) at the most recent update. During childhood, mean HbA1c decreased from 8.3% (67 mmol/mol) in 2-4-year-olds to 8.1% (65 mmol/mol) at 7 years of age, followed by an increase to 9.2% (77 mmol/mol) in 19-year-olds. Subsequently, mean HbA1c values decline gradually until ∼30 years of age, plateauing at 7.5-7.8% (58-62 mmol/mol) beyond age 30 until a modest drop in HbA1c below 7.5% (58 mmol/mol) in those 65 years of age. Severe hypoglycemia (SH) and diabetic ketoacidosis (DKA) remain all too common complications of treatment, especially in older (SH) and younger patients (DKA). Insulin pump use increased slightly from enrollment (58-62%), and use of continuous glucose monitoring (CGM) did not change (7%). Although the T1D Exchange registry findings are not population based and could be biased, it is clear that there remains considerable room for improving outcomes of treatment of type 1 diabetes across all age-groups. Barriers to more effective use of current treatments need to be addressed and new therapies are needed to achieve optimal metabolic control in people with type 1 diabetes.
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              The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study at 30 Years: Overview

              David M Nathan, (2013)
              OBJECTIVE The Diabetes Control and Complications Trial (DCCT) was designed to test the glucose hypothesis and determine whether the complications of type 1 diabetes (T1DM) could be prevented or delayed. The Epidemiology of Diabetes Interventions and Complications (EDIC) observational follow-up determined the durability of the DCCT effects on the more-advanced stages of diabetes complications including cardiovascular disease (CVD). RESEARCH DESIGN AND METHODS The DCCT (1982–1993) was a controlled clinical trial in 1,441 subjects with T1DM comparing intensive therapy (INT), aimed at achieving levels of glycemia as close to the nondiabetic range as safely possible, with conventional therapy (CON), which aimed to maintain safe asymptomatic glucose control. INT utilized three or more daily insulin injections or insulin pump therapy guided by self-monitored glucose. EDIC (1994–present) is an observational study of the DCCT cohort. RESULTS The DCCT followed >99% of the cohort for a mean of 6.5 years and demonstrated a 35–76% reduction in the early stages of microvascular disease with INT, with a median HbA1c of 7%, compared with CONV, with a median HbA1c of 9%. The major adverse effect of INT was a threefold increased risk of hypoglycemia, which was not associated with a decline in cognitive function or quality of life. EDIC showed a durable effect of initial assigned therapies despite a loss of the glycemic separation (metabolic memory) and demonstrated that the reduction in early-stage complications during the DCCT translated into substantial reductions in severe complications and CVD. CONCLUSIONS DCCT/EDIC has demonstrated the effectiveness of INT in reducing the long-term complications of T1DM and improving the prospects for a healthy life span.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Diabetes
                Journal ID (iso-abbrev): Clin Diabetes
                Journal ID (publisher-id): clinical diabetes
                Title: Clinical Diabetes : A Publication of the American Diabetes Association
                Publisher: American Diabetes Association
                ISSN (Print): 0891-8929
                ISSN (Electronic): 1945-4953
                Publication date (Print): Winter 2023
                Publication date (Electronic): 30 August 2022
                Publication date PMC-release: 30 August 2022
                Volume: 41
                Issue: 1
                Pages: 68-75
                Affiliations
                [1 ]Rady Children’s Hospital, University of California, San Diego, CA
                [2 ]T1D Exchange, Boston, MA
                [3 ]University of Mississippi School of Population Health, Jackson, MI
                [4 ]Children’s National Health System, Washington, DC
                [5 ]Cincinnati Children’s Hospital, Cincinnati, OH
                [6 ]Children’s Mercy–Kansas City, Kansas City, MO
                [7 ]Le Bonheur Children’s Hospital, University of Tennessee, Jackson, TN
                [8 ]SUNY Upstate Medical University, Syracuse, NY
                [9 ]Nationwide Children’s Hospital, The Ohio State University, Columbus, OH
                [10 ]Department of Pediatrics, University of Florida, Gainesville, FL
                Author notes
                [*]

                Co-first authors

                Corresponding author: Carla Demeterco-Berggren, cdemeterco@ 123456rchsd.org
                Author information
                https://orcid.org/0000-0002-1140-644X
                https://orcid.org/0000-0002-8473-249X
                https://orcid.org/0000-0002-5144-7836
                Article
                Publisher ID: CD220073
                DOI: 10.2337/cd22-0073
                PMC ID: 9845079
                PubMed ID: 36714245
                SO-VID: 1b172c21-34f7-4623-a124-57202dd02b41
                Copyright © © 2022 by the American Diabetes Association
                License:

                Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at https://diabetesjournals.org/journals/pages/license.

                History
                Page count
                Pages: 8
                Funding
                Funded by: Leona M. and Harry B. Helmsley Charitable Trust, DOI 10.13039/100007028;
                Funded by: T1DX-QI Collaborative;
                Categories
                Subject: Feature Articles

                Data availability:

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