Anastasia Albanese-O'Neill1, Julia M Grimsmann2,3, Ann-Marie Svensson4,5, Kellee M Miller6, Klemens Raile7, Karin Akesson8,9, Peter Calhoun6, Beate Biesenbach10, Katarina Eeg-Olofsson5, Reinhard W Holl2,3, David M Maahs11,12, Ragnar Hanas13,14. 1. Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA. 2. Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany. 3. German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany. 4. Centre of Registers in Region Västra Götaland, Gothenburg, Sweden. 5. Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden. 6. Jaeb Center for Health Research, Tampa, Florida, USA. 7. Department of Pediatric Endocrinology and Diabetes, Charité-Universitätsmedizin Berlin, Berlin, Germany. 8. Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. 9. Department of Paediatrics, County Hospital Ryhov, Jönköping, Sweden. 10. Department of Pediatrics, University Hospital Linz, Kepler University, Linz, Austria. 11. Division of Pediatric Endocrinology, Stanford Diabetes Research Center, Stanford, California, USA. 12. Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California, USA. 13. Department of Pediatrics, NU Hospital Group, Uddevalla, Sweden. 14. Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Abstract
Aims: This study assessed hemoglobin A1c (HbA1c) across the lifespan in people with type 1 diabetes (T1D) in Germany/Austria, Sweden, and the United States between 2011 and 2017 to ascertain temporal and age-related trends. Methods: Data from the Diabetes-Patienten-Verlaufsdokumentation (DPV) (n = 25,651 in 2011, n = 29,442 in 2017); Swedish Pediatric Diabetes Quality Registry (SWEDIABKIDS)/National Diabetes Register (NDR), (n = 44,474 in 2011, n = 53,690 in 2017); and T1D Exchange (n = 16,198 in 2011, n = 17,087 in 2017) registries were analyzed by linear regression to compare mean HbA1c overall and by age group. Results: Controlling for age, sex, and T1D duration, HbA1c increased in the United States between 2011 and 2017, decreased in Sweden, and did not change in Germany/Austria. Controlling for sex and T1D duration, mean HbA1c decreased between 2011 and 2017 in all age cohorts in Sweden (P < 0.001). In the United States, HbA1c stayed the same for participants <6 years and 45 to <65 years and increased in all other age groups (P < 0.05). In Germany/Austria, HbA1c stayed the same for participants <6 to <13 years and 18 to <25 years; decreased for participants ages 13 to <18 years (P < 0.01); and increased for participants ≥25 years (P < 0.05). Conclusions: The comparison of international trends in HbA1c makes it possible to identify differences, explore underlying causes, and share quality improvement processes. National quality improvement initiatives are well accepted in Europe but have yet to be implemented systematically in the United States. However, disparities created by the lack of universal access to health care coverage, unequal access to diabetes technologies (e.g., continuous glucose monitoring) regardless of insurance status, and high out-of-pocket cost for the underinsured ultimately limit the potential of quality improvement initiatives.
Aims: This study assessed hemoglobin A1c (HbA1c) across the lifespan in people with type 1 diabetes (T1D) in Germany/Austria, Sweden, and the United States between 2011 and 2017 to ascertain temporal and age-related trends. Methods: Data from the Diabetes-Patienten-Verlaufsdokumentation (DPV) (n = 25,651 in 2011, n = 29,442 in 2017); Swedish Pediatric Diabetes Quality Registry (SWEDIABKIDS)/National Diabetes Register (NDR), (n = 44,474 in 2011, n = 53,690 in 2017); and T1D Exchange (n = 16,198 in 2011, n = 17,087 in 2017) registries were analyzed by linear regression to compare mean HbA1c overall and by age group. Results: Controlling for age, sex, and T1D duration, HbA1c increased in the United States between 2011 and 2017, decreased in Sweden, and did not change in Germany/Austria. Controlling for sex and T1D duration, mean HbA1c decreased between 2011 and 2017 in all age cohorts in Sweden (P < 0.001). In the United States, HbA1c stayed the same for participants <6 years and 45 to <65 years and increased in all other age groups (P < 0.05). In Germany/Austria, HbA1c stayed the same for participants <6 to <13 years and 18 to <25 years; decreased for participants ages 13 to <18 years (P < 0.01); and increased for participants ≥25 years (P < 0.05). Conclusions: The comparison of international trends in HbA1c makes it possible to identify differences, explore underlying causes, and share quality improvement processes. National quality improvement initiatives are well accepted in Europe but have yet to be implemented systematically in the United States. However, disparities created by the lack of universal access to health care coverage, unequal access to diabetes technologies (e.g., continuous glucose monitoring) regardless of insurance status, and high out-of-pocket cost for the underinsured ultimately limit the potential of quality improvement initiatives.
Entities:
Keywords:
Benchmarking; Epidemiology; Quality improvement; Type 1 diabetes