HbA1c remains suboptimal for most people with type 1 diabetes
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In an analysis of HbA1c data from 22 nations, most children and adults with type 1 diabetes do not have an HbA1c of less than 7.5%, though glycemic control varies greatly by age and country, according to study data.
Researchers from the Scottish Diabetes Research Network Epidemiology Group conducted a follow-up to their 2014 study, which analyzed data compiled from 2010 to 2012 from 324,501 people with type 1 diabetes. The earlier study showed glycemic control varied greatly across data sources and age groups, though most people with type 1 diabetes had an HbA1c of greater than 7.5%. Similar findings were observed in the follow-up study, which analyzed more recent HbA1c data from 2016 to 2020.
“Our data, describing glycemic control from over half a million people with type 1 diabetes across 22 different countries, clearly demonstrate the challenge of achieving lower HbA1c targets to minimize the risk of developing long-term complications,” Sarah H. Wild, MSc, PhD, professor of epidemiology in the Usher Institute at University of Edinburgh in the U.K., and colleagues wrote in a study published in Diabetic Medicine. “Glycemic control continues to vary substantially between age groups, countries and type of data source, with large proportions of people with HbA1c greater than 9%, particularly among people aged 15 to 24 years.”
Researchers compiled HbA1c data for people with type 1 diabetes from 17 population-based sources and five clinic-based sources in 22 countries. All data were compiled between 2016 and 2020 and included age, sex, diabetes duration and continuous subcutaneous insulin infusion use. Researchers examined the proportion of participants with an HbA1c of less than 7.5%, between 7.5% and 8.9%, and 9% or higher.
Data from 520,392 people with type 1 diabetes were included, of whom 54,158 were children younger than 15 years, 83,065 were young adults aged 15 to 24 years, and 382,907 were adults aged 25 years and older. The analysis included population-based registers in Austria, Australia, Belgium, Denmark, England, Finland, Germany, Hong Kong, Italy, Latvia, New Zealand, Norway, Scotland, Slovenia, Sweden, Ukraine and Wales; and five clinic-based registers from Canada, France, Greece, Ireland and the Netherlands.
Median HbA1c varied greatly from 7.2% to 9.4% across different populations and age groups. The proportion of people using continuous subcutaneous insulin infusion also varied widely in all three age groups.
After adjusting for sex, age and data source, individuals in the five clinic-based data sources were more likely to have an HbA1c of less than 7.5% than those from population-based data sources (adjusted OR = 1.24; 95% CI, 1.19-1.3). Women were less likely to meet that target than men (aOR = 0.91; 95% CI, 0.9-0.92). Children younger than 15 years were more likely to have an HbA1c of less than 7.5% than adults aged 25 years (aOR = 1.42; 95% CI, 1.39-1.46), but those aged 15 to 24 years were less likely to meet an HbA1c target of less than 7.5% than adults (aOR = 0.77; 95% CI, 0.76-0.78).
“We have demonstrated differences in glycemic control in different populations and age groups and shown that differences persist between populations over time,” the researchers wrote. “Further research is required to better understand whether apparent differences between health systems may relate to such influences as societal factors, structure and delivery of clinical care and resource allocation. Their better understanding could help inform development of cost-effective interventions to improve outcomes.”
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