PHILADELPHIA – U.S. patients with type 1 diabetes who maintain excellent glycemic control have the best diabetes-control practices, use a pump, and have higher incomes and educational attainment, compared with patients who maintain fair or poor glycemic control, based on data collected from more than 2,000 registry patients.
Patients with excellent control had, by definition, the lowest levels of hemoglobin A1c, and also had a quarter of the episodes of diabetic ketoacidosis as did the patients who maintained fair or poor glycemic control, Elaine Massaro, R.N., said at the annual meeting of the American Association of Diabetes Educators.
But better glycemic control did not result in an increased incidence of severe hypoglycemic episodes; the rate of severe hypoglycemia was 13% during the preceding 12 months among patients with excellent glycemic control and those with fair or poor control, said Ms. Massaro, an advanced practice nurse at Northwestern University in Chicago.
Between September 2010 and May 2013, more than 26,000 U.S. adult and pediatric patients with type 1 diabetes treated at any of 70 participating centers enrolled in the T1D Exchange Clinic Registry. From the total group of enrollees, Ms. Massaro and her associates identified 714 patients (3%) who, at their entry examination, were at least 26 years old, had been diagnosed with type 1 diabetes for at least 2 years, were not using a real-time continuous glucose monitor, and had excellent glycemic control, with a HbA1c of less than 6.5%. The researchers also identified a second subgroup of 1,343 (5%) from the registered patients who matched the first group by age, duration of diagnosis, and lack of continuous monitoring, but differed by having fair or poor glycemic control, with a HbA1c of 8.5% or higher.
Mitchel L. Zoler/IMNG Medical Media
Elaine Massaro
Comparison of these two subgroups identified several factors that significantly correlated with excellent glycemic control. For example, 68% of patients with excellent control never missed an insulin dose, compared with 32% of those with fair or poor control. The prevalence of patients who said they self-monitored their blood glucose more than five times a day was 58% among those with excellent control and 23% among those with fair or poor control.
Four times as many patients with fair or poor control reported having an episode of diabetic ketoacidosis during the prior 12 months, compared with patients who maintained excellent glycemic control (12% vs. 3%).
The analysis failed to find any correlation between the level of glycemic control and the type of insulin that patients used, or whether they administered a long-acting insulin formulation once or twice a day. The results also showed that insulin pump use was significantly more prevalent among patients with excellent glycemic control than among those with fair or poor control, but Ms. Massaro did not report specific rates of pump use in the two subgroups.
Ms. Massaro had no disclosures.
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