The Transatlantic HbA1c gap: differences in glycaemic control across the lifespan between people included in the US T1D Exchange Registry and those included in the German/Austrian DPV registry. Issue 5 (14th October 2019)

• Record Type: Journal Article
• Authors: Hermann, J. M.; Miller, K. M.; Hofer, S. E.; Clements, M. A.; Karges, W.; Foster, N. C.; Fröhlich‐Reiterer, E.; Rickels, M. R.; Rosenbauer, J.; DeSalvo, D. J.; Holl, R. W.; Maahs, D. M.
• Is Part Of: Diabetic medicine. Volume 37:Issue 5(2020)
• Page Start: 848
• Page End: 855
• Publication Date: 2019-10-14
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.14148
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aim: To compare HbA1c levels across the lifespan in people with type 1 diabetes in the USA with those in Germany/Austria, and to examine potential differences in HbA1c levels between sexes, insulin delivery methods and minority status. Methods: Data were extracted from the US T1D Exchange Registry ( n =18 381 participants from 73 sites) and from the German/Austrian Prospective Diabetes Follow‐up Registry, the DPV ( n =32 643 participants from 362 sites). Mean HbA1c was calculated for each year of age for individuals aged ≤25 years, and at 2‐year age intervals for individuals aged >25 years. Curves for mean HbA1c by age were estimated using locally weighted scatterplot smoothing. HbA1c differences between registries, sexes, insulin delivery methods, and minority status were assessed by age group using multiple linear regression. Results: In both registries, mean HbA1c increased by ~11 mmol/mol (1.0%) between the ages of 9 and 18 years, although at quite different absolute levels: from 66 mmol/mol (8.2%) to 77 mmol/mol (9.2%) in the T1D Exchange Registry, and from 56 mmol/mol (7.3%) to 66 mmol/mol (8.2%) in the DPV. Sex differences were observed in the DPV only. In the T1D Exchange Registry, injection users had higher mean HbA1c than pump users across the lifespan, whereas in the DPV higher HbA1c levels in injection users were observed in the age groups 6 to <12 years, 12 to <18 years, and 30 to <50 years ( P < 0.001). Minority status was significantly associated with higher HbA1c in most age groups in both registries. Conclusions: Significant differences in HbA1c were noted between the USA and Germany/Austria, with disparities more pronounced in early childhood through to young adulthood. Further studies should identify causes for these disparities. What's new?: Data from the TID Exchange Registry (T1DX) have shown that only few individuals with type 1 diabetes meet HbA1c targets, and that glycaemic control has worsened in adolescents over recent years. Although a similar increase in HbA1c on reaching adolescence was observed, young people in the German/Austrian DPV registry had HbA1c levels that were ˜11 mmol/mol (1.0%) lower compared with young people included in the T1DX. Comparison of the two contemporary diabetes cohorts showed large discrepancies in glycaemic control between developed Western countries, and highlights the need for increased efforts to improve care and particularly to lower HbA1c in young people with type 1 diabetes, especially those included in the T1DX.