SEARCH: HbA1c rising for youths with diabetes despite technology, new therapies
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A substantial percentage of youths and young adults with diabetes in the U.S. are not achieving recommended glycemic outcomes despite newer therapies and greater availability of diabetes technology, according to SEARCH study data.
In particular, youths and young adults with type 1 diabetes aged 10 to 24 years continue to have worse glycemic response compared with the 2002-2007 cohort of SEARCH participants, Faisal Malik, MD, MSHS, assistant professor of pediatrics at the University of Washington School of Medicine and investigator at the Center for Child Health, Behavior and Development at Seattle Children's Research Institute, said during a presentation at the virtual American Diabetes Association Scientific Sessions.
“Our finding that current youth and young adults with diabetes are not demonstrating improved glycemic control compared with earlier cohorts in the SEARCH study was surprising, given how the landscape of diabetes management has changed dramatically during the past decade,” Malik told Healio. “These results suggest that not all youth and young adults with diabetes are directly benefiting from the increased availability of diabetes technology, newer therapies, and the use of more aggressive glycemic targets for youth with diabetes over time.”
SEARCH for Diabetes in Youth, funded by the CDC and the National Institute of Diabetes and Digestive and Kidney Diseases, is a national, multicenter study launched in 2000 designed to understand more about diabetes among children and young adults in the United States. SEARCH study centers are located in California, Colorado, Ohio, South Carolina and Washington, and more than 20,000 participants are enrolled.
Malik and colleagues analyzed data from 6,492 SEARCH participants with diabetes for at least 1 year. Visit data were categorized into three periods: 2002-2007 (3,451 with type 1 diabetes; 379 with type 2 diabetes), 2008-2013 (2,254 with type 1 diabetes; 327 with type 2 diabetes), and 2014-2019 (1,809 with type 1 diabetes; 519 with type 2 diabetes); stratified by three periods of diabetes duration: 1 to 4 years, 5 to 9 years, and at least 10 years. Participants contributed one randomly selected data point to each duration group. Researchers used stratified regression models to test differences in HbA1c over time, adjusted for site, age, sex, race, health insurance status and disease duration, both overall and for each duration group.
Researchers found that estimated mean HbA1c among individuals with type 1 diabetes was different across the three periods with a higher mean HbA1c during 2014-2019 (mean, 8.7%) and 2008-2013 (mean, 8.9%) compared with 2002-2007 (mean, 8.6%; P < .01). There was a temporal difference in mean HbA1c for participants with type 1 diabetes for 5 to 9 years (P < .01) and for participants with type 2 diabetes at least 10 years (P < .01).
“We found that the estimated average HbA1c for the most recent cohort of youth and young adults with type 1 diabetes was 8.7%, whereas youth and young adults with type 2 diabetes had an estimated average HbA1c of 8.5%,” Malik said. “Overall, youth and young adults with diabetes who had study visits between 2014 and 2019 had average HbA1c levels that were comparable to earlier SEARCH cohorts. However, current youth and young adults with type 1 diabetes in the 10 to 14, 15 to 19, and 20 to 24 age groups continue to have worse glycemic control than the 2002-2007 cohort. Similarly, participants aged 25 years and older with type 2 diabetes exhibit a temporal trend of worse glycemic control relative to earlier time periods.”
In an interview, Malik said the findings highlight that a substantial percentage of current youth and young adults with diabetes are not meeting HbA1c goals recommended by the ADA.
“Given the evidence highlighting the benefits of tight glycemic control, this study reinforces the need for interventions that combine the use of diabetes technology with effective behavioral and social approaches to improve glycemic control for the highly diverse group of youth and young adults living with diabetes in the U.S.,” Malik said.
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Malik F, et al. Trends in glycemic control among youth with diabetes: The Search for Diabetes in Youth study. Presented at: American Diabetes Association Scientific Sessions; June 12-16, 2020 (virtual meeting).
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