Differences between patients with type 1 diabetes with optimal and suboptimal glycaemic control: A real‐world study of more than 30 000 patients in a US electronic health record database

Abstract

Aims To use electronic health record data from real‐world clinical practice to assess demographics, clinical characteristics and disease burden of adults with type 1 diabetes (T1D) in the United States. Materials and methods Retrospective observational study of adults with T1D for ≥24 months at their first visit with a T1D diagnosis code (“index date”) between July 2014 and June 2016 in the Optum Humedica database. Demographic characteristics, acute complications (severe hypoglycaemia [SH], diabetic ketoacidosis [DKA]), microvascular complications, cardiovascular (CV) events and health care resource utilization during the 12 months before the index date (“baseline period”) were compared between patients with optimal versus suboptimal glycaemic control (glycated haemoglobin [HbA1c] <7.0% vs. ≥7.0% [53 mmol/mol]) at the closest measurement to the index date. Results Of 31 430 adults with T1D, 79.9% had suboptimal glycaemic control (mean HbA1c 8.8% [73 mmol/mol]). These patients were more likely to be younger, African American, uninsured or on Medicaid, obese, smokers, have uncontrolled hypertension and have depression. Despite worse glycaemic control and increased CV risk factors of uncontrolled hypertension, obesity and smoking, rates of coronary heart disease and stroke were not higher in these patients. Patients with suboptimal glycaemic control also experienced more diabetes complications (including SH, DKA and microvascular disease) and utilized more emergency care, with more emergency department visits and inpatient stays. Conclusion This real‐world study of >30 000 adults with T1D showed that individuals with suboptimal versus optimal glycaemic control differed significantly in terms of health care coverage, comorbidities, diabetes‐related complications, health care utilization and CV risk factors. However, suboptimal control was not associated with increased risk of CV outcomes.

Clinical Characteristics and Degree of Glycemic and Cardiovascular Risk Factor Control in Patients with Type 1 Diabetes in Catalonia (Spain)

“…This finding is of concern, and more emphasis on smoking cessation and prevention programs may be warranted in the management of these patients. Of note, while our population compares poorly with some [ 23 , 34 ], some cohorts in other countries have also shown a similar or higher prevalence of smoking [ 14 , 17 ], suggesting the importance of smoking interventions elsewhere and in general. Finally, the prevalence of overweight and obesity was higher than previously reported [ 35 ], mirroring the increased prevalence of this emerging risk factor in the background population.…”

Nutrition and Obesity in the Pathogenesis of Youth-Onset Type 1 Diabetes and Its Complications

“…hypertension, dyslipidemia), the CACTI study identified obesity as a risk factor for both the presence and progression of coronary artery calcifications independent of pre-existing metabolic abnormalities ( 106 ). How this translates to long-term cardiovascular morbidity and mortality is less clear ( 107 ). The Pittsburgh EDC study demonstrated that waist circumference, a surrogate of visceral adiposity, increases the risk for long-term mortality in type 1 diabetes ( 108 ).…”

The Canadian LMC Diabetes Registry: A Profile of the Demographics, Management, and Outcomes of Individuals with Type 1 Diabetes

“…In type 1 diabetes (T1D), several large-scale population registries have emerged, including the Swedish National Diabetes Register (NDR), 1 the Diabetes-Patienen-Verlaufsdokumentation databases (DPV), 2 the German Diabetes Versorgungs-Evaluation (DIVE), 3 and others. 4,5 In the past decade, the Type 1 Diabetes Exchange Clinic Registry (T1DX), 6 an invited clinic-based cooperative, and the Optum Humedica database 7 have provided similar reports in the United States. In Canada, the Canadian Study of Longevity in T1D has particularly studied adults with T1D >50 years.…”

“…6,[10][11][12][13] For example, several registries have recently updated their reports to again confirm that even with recent advances in therapies and technologies, only a minority actually achieves recommended targets. 7,10,11 An accurate and constant awareness of the clinical status of people with T1D is necessary to inform the feasibility of current guidelines and the need for future strategy redevelopment. The Canadian LMC Diabetes Registry comprises the health records of one of the largest endocrine practice groups globally, with >50 endocrinologists across three Canadian provinces.…”