Mean HbA1c declines for people with type 1 diabetes from 2016 to 2022
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Key takeaways:
- Children and adults attending clinics in the T1D Exchange Quality Improvement Collaborative had a drop in mean HbA1c from 2016 to 2022.
- More work is needed to address racial-ethnic and insurance inequities.
Mean HbA1c for children and adults with type 1 diabetes improved by 0.3 percentage points from 2016 to 2022, according to data from 15 clinics participating in the T1D Exchange Quality Improvement Collaborative.
“We are pleased to see the amazing news that finally glycemic outcomes are improving for people with type 1 diabetes,” Osagie Ebekozien, MD, MPH, CPHQ, chief medical officer at T1D Exchange, told Healio. “We see significant positive improvements in outcomes for everyone across all racial-ethnic, insurance and age groups. This is very encouraging considering that the prior 2019 T1D Exchange study showed worsening glycemic outcomes.”
Ebekozien and colleagues collected HbA1c data from three adult diabetes clinics and 12 pediatric clinics that are part of the T1D Exchange Quality Improvement Collaborative. People with type 1 diabetes who had at least one HbA1c recorded for each year from 2016 to 2022 were included. Mean HbA1c values from 2016 to 2017 were compared with 2021 to 2022. The percentages of participants with an HbA1c of less than 7% or more than 9% were calculated. Researchers analyzed mean HbA1c by age, race and ethnicity, insurance type and diabetes device use.
The findings were published in Diabetes Technology & Therapeutics.
More people achieving HbA1c of less than 7%
The study population had a decrease in mean HbA1c from 8.7% in 2016-2017 to 8.4% in 2021-2022 (P < .01). The percentage of people with an HbA1c of less than 7% increased from 20% in 2016-2017 to 26% in 2021-2022, and the proportion of those with an HbA1c of more than 9% dropped from 43% to 31% in that same period.
Ebekozien said several factors have contributed to the recent HbA1c decline, including an increase in the use of diabetes technology, a strong culture of improvement among the centers in the T1D Exchange Quality Improvement Collaborative and the success of advocacy efforts to support clinic- and state-level policy changes.
Among age groups, adolescents and young adults aged 16 to 25 years had the biggest decline in HbA1c, though a decrease in HbA1c from 2016-2017 to 2021-2022 was observed for all age groups.
Racial-ethnic, insurance disparities
When racial-ethnic groups were analyzed, non-Hispanic white participants had an HbA1c decline from 8.6% in 2016-2017 to 8% in 2021-2022. Hispanic people also had a decrease in HbA1c from 9% in 2016-2017 to 8.6% in 2021-2022. HbA1c remained relatively stable for non-Hispanic Black participants.
Across all 7 years in the study, white people had a 0.5 percentage point lower HbA1c than Hispanic participants and a 1.4 percentage point lower HbA1c than Black people. Racial-ethnic disparities remained after controlling for age, sex and duration of diabetes. Inequities between white people and Black or Hispanic participants were seen for HbA1c and diabetes device use across the study period.
Mean HbA1c decreased for people with both private and public insurance. People with private insurance had a 0.5 percentage point decline in HbA1c from 2016-2017 to 2021-2022; whereas those with public insurance had an HbA1c decrease of 0.3 percentage points.
“We observed in adjusted analysis that the equity gaps were worse for people with type 1 diabetes of a minority race or ethnicity, public insurance and limited access to diabetes technologies,” Ebekozien said. “The current equity gaps are still troubling and requires our undivided attention.”
White people with type 1 diabetes were more likely to have an HbA1c of less than 7% than Black or Hispanic participants (OR = 1.34; 95% CI, 1.23-1.45; P < .001). People with private insurance were more likely to have an HbA1c of less than 7% than those with public insurance (OR = 1.96; 95% CI, 1.84-2.09; P < .001).
Moving forward, Ebekozien said more support is needed for equity-focused interventions to reduce barriers for Black and Hispanic people with type 1 diabetes as well as those with public insurance. He added that more studies are needed to understand contributors and strategies for improving glycemic outcomes among adolescents and young adults with type 1 diabetes.
“It is time for a national type 1 diabetes quality program that will align all stakeholders with the right incentives for improved outcomes,” Ebekozien said.
For more information:
Osagie Ebekozien, MD, MPH, can be reached at oebekozien@td1exchange.org.
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