Poor Disease Control Among Type 1 Adolescents and Young Adults with Type 1

Advanced technologies and treatments should be implemented to improve metabolic control and outcomes in type 1 diabetic patients…

An analysis to assess current diabetes treatments performed by T1D Exchange researchers shows a need for improvement in outcomes across all age groups, most notably adolescents and young adults. More than 16,000 patients aged 2-95 were evaluated by Exchange researchers by examining HbA1c with data being collected once between September 2010-August 2012 and again from September 2013-December 2014.

The average HbA1c level was 8.4 with the poorest outcomes among individuals aged 13 to 25. Adolescents had an average HbA1c of 9 with minimal improvements since the 1992 Diabetes Control and Complications Trial (DCCT) when the average HbA1c was 9.5. The recommended HbA1c of 7 was only met by 14% of young adults aged between 18-25 as compared with 30% of older adults.

This age group in particular faces unique challenges to diabetes management, including hormone fluctuations affecting blood sugar control, the overwhelming demands of diabetes self-care, which may lead to complications.

Greater access to technologies such as continuous glucose monitors (CGMs), insulin pumps, the artificial pancreas, smarter insulins and non-insulin therapies is key in order to improve glycemic control the researchers said. In addition, they found that the use of CGMs is increasing, but continues to remain low. With regards to the use of glucose lowering agents in addition to insulin, metformin was the most common, however, it was only being used by 6% of participants aged 26 and older. Other non-insulin therapies were used by less than 2% of participants 26 years and older and by less than 1% in participants under the age of 25.

Henry Anhalt, DO and T1D Exchange chief medical officer said that, “Analysis of the clinic registry data reveals that high proportions of individuals are simply not achieving glycemic targets with current therapies. This only sharpens our focus for the absolute need for the development and dissemination of an artificial pancreas, safe and effective islet replacement, development of smarter insulins and non-insulin therapies, and rigorous quality improvement in clinical care.”

Practice Pearls:

• All age groups showed an average HbA1c of 8.4 with the poorest outcomes among adolescents and young adults who averaged an HbA1c of 9.
• Minimal improvements in outcomes have been seen since the initial Diabetes Control and Complications Trial, published in 1992.
• Advancements in technologies such as an artificial pancreas, the use of non-insulin therapies and continuous glucose monitoring may improve outcomes in patients moving forward.

Diabetes Care May 22, 2015 T1D Exchange Clinic researchers. “Treatment outcomes in type 1 diabetes could be improved across all ages.”