Differences in the Management of Type 1 Diabetes Among Adults Under Excellent Control Compared With Those Under Poor Control in the T1D Exchange Clinic Registry

OBJECTIVE

Optimizing glycemic control in type 1 diabetes is important to minimize the risk of complications. We used the large T1D Exchange clinic registry database to identify characteristics and diabetes management techniques in adults with type 1 diabetes, differentiating those under excellent glycemic control from those with poorer control.

RESEARCH DESIGN AND METHODS

The cross-sectional analysis included 627 participants with HbA_1c <6.5% (excellent control) and 1,267 with HbA_1c ≥8.5% (fair/poor control) at enrollment who were ≥26 years of age (mean ± SD 45.9 ± 13.2 years), were not using continuous glucose monitoring, and had type 1 diabetes for ≥2 years (22.8 ± 13.0 years).

RESULTS

Compared with the fair/poor control group, participants in the excellent control group had higher socioeconomic status, were more likely to be older and married, were less likely to be overweight, were more likely to exercise frequently, and had lower total daily insulin dose per kilogram (P < 0.0001 for each). Excellent control was associated with more frequent self-monitoring of blood glucose (SMBG), giving mealtime boluses before a meal rather than at the time of or after a meal, performing SMBG before giving a bolus, and missing an insulin dose less frequently (P < 0.0001 for each). Frequency of severe hypoglycemia was similar between groups, whereas diabetic ketoacidosis was more common in the fair/poor control group.

CONCLUSIONS

Diabetes self-management related to insulin delivery, glucose monitoring, and lifestyle tends to differ among adults with type 1 diabetes under excellent control compared with those under poorer control. Future studies should focus on modifying diabetes management skills in adult type 1 diabetes patients with suboptimal glycemic control.The Diabetes Control and Complications Trial (DCCT) demonstrated that lowering average blood glucose levels leads to decreased microvascular and macrovascular complications (1,2). In the intervening years, much advancement has been made in an attempt to improve diabetes management through the development of insulin analogs, improvement of insulin infusion pumps, and development of continuous glucose monitoring (CGM) systems. Certified diabetes education programs provide evidence-based information to patients on ways to achieve optimal diabetes control, and in the current digital era, information about the carbohydrate content of food is at the fingertips of many patients. However, although some patients have excellent glycemic control on the basis of HbA_1c values, it is not always apparent how their diabetes management differs from patients who have poor diabetes control. The large T1D Exchange clinic registry database provides an opportunity to cross-sectionally analyze differences in patient characteristics as well as aspects of diabetes management in adult patients with HbA_1c values in the excellent range compared with those with values in the fair/poor range.