Study finds poor treatment results for US teens with type 1 diabetes

by Barbara Hewitt on May 25, 2015

There is considerable room for improving treatment outcomes in type 1 diabetes across all age groups in the United States, but especially for adolescents and young adults, a new study has found.

The analysis of the current state of diabetes treatment says that little has changed in the last 25 years and new technologies are needed to help teenagers manage their condition.

Young people

The study says new technologies are needed to help teenagers manage their condition

The findings, published in a special issue of Diabetes Care, come from data collected by the T1D Exchange Clinic Registry. Researchers from the Exchange evaluated data from more than 16,000 patients ages two to 95.

A key area of study was glycaemic control across the age spectrum, determined by examining Haemoglobin A1c (HbA1c) levels, a standard test of average blood sugar levels over two to three months. According to the American Diabetes Association, the recommended target A1c level is less than 7% for adults with type 1 diabetes and less than 7.5% those under the age of 19.

Researchers found that while 8.4% remains the average A1c level across the registry, A1c levels are notably worse among 13 to 25 year olds and have barely changed since the initial Diabetes Control and Complications Trial (DCCT) results were published in 1992.

Adolescents in the registry averaged a 9% A1c compared with the 9.5% registered by the same age group during the DCCT, indicating that advances in diabetes management over the past two decades have been less successful in overcoming the special challenges in managing teenagers with the disease.

The majority of young adults in their 20s do not fully achieve glycaemic control until they are 30 and only 14% of those between 18 and 25 years old met the recommended 7% compared with 30% of older adults.

‘While disease management at every age needs to improve, it’s especially disconcerting how poorly we continue to manage type 1 diabetes in adolescents,’ said Kellee Miller, assistant director, epidemiologist and statistician at the Jaeb Centre for Health Research.

‘This age group in particular faces unique challenges to diabetes management, including hormone fluctuations that affect blood sugar control, the sometimes overwhelming demands of diabetes self-care and even phases of rebelling against parents and physicians, which may lead to complications treating their disease,’ added Miller.

According to the researchers, it is imperative to provide greater access to technologies such as continuous glucose monitors (CGM) and insulin pumps, and to advance better treatment options such as the artificial pancreas, smarter insulins and non-insulin therapies. Such advances would likely help increase glycaemic control for the majority of type 1 diabetes patients.

‘Our data show that while advances have been made in type 1 diabetes, the condition remains a tremendous burden, particularly in youth. This only furthers our resolve to accelerate the research that is going to reduce burden of living with type 1 diabetes and improve outcomes,’ said Dana Ball, executive director and co-founder of the Exchange.

The research also assessed use of advanced diabetes technologies, insulin and other glucose-lowering agents and found that insulin pumps are used by 60% of registrants, with the largest increase in pump use among those aged six to 12. Pump use did not change among 18 to 25 year olds and increased only slightly in older adults.

Across all age groups, the use of continuous glucose monitoring (CGM) is low but increasing, the lowest rate being among younger patients and the use of glucose-lowering agents in addition to insulin treatment was uncommon across all age groups.

‘Analysis of the clinic registry data reveals that high proportions of individuals are simply not achieving glycaemic targets with current therapies. This only sharpens our focus for the absolute need for the development and dissemination of an artificial pancreas, safe and effective islet replacement, development of smarter insulins and non-insulin therapies, and rigorous quality improvement in clinical care,’ said Henry Anhalt, chief medical officer at T1D Exchange.

The opinions expressed in this article do not necessarily reflect the views of the Community and should not be interpreted as medical advice. Please see your doctor before making any changes to your diabetes management plan.

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