Cited by 1,254Diabetes Management and ResearchDiabetes Management and EducationDiabetes and associated disorders

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Current State of Type 1 Diabetes Treatment in the U.S.: Updated Data From the T1D Exchange Clinic Registry

Miller, Kellee M., Foster, Nicole C., Beck, Roy W., Bergenstal, Richard M., DuBose, Stephanie N., DiMeglio, Linda A., Maahs, David M., Tamborlane, William V.·2015·Diabetes Care

DOI 10.2337/dc15-0078

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Abstract

To examine the overall state of metabolic control and current use of advanced diabetes technologies in the U.S., we report recent data collected on individuals with type 1 diabetes participating in the T1D Exchange clinic registry. Data from 16,061 participants updated between 1 September 2013 and 1 December 2014 were compared with registry enrollment data collected from 1 September 2010 to 1 August 2012. Mean hemoglobin A1c (HbA1c) was assessed by year of age from <4 to >75 years. The overall average HbA1c was 8.2% (66 mmol/mol) at enrollment and 8.4% (68 mmol/mol) at the most recent update. During childhood, mean HbA1c decreased from 8.3% (67 mmol/mol) in 2–4-year-olds to 8.1% (65 mmol/mol) at 7 years of age, followed by an increase to 9.2% (77 mmol/mol) in 19-year-olds. Subsequently, mean HbA1c values decline gradually until ∼30 years of age, plateauing at 7.5–7.8% (58–62 mmol/mol) beyond age 30 until a modest drop in HbA1c below 7.5% (58 mmol/mol) in those 65 years of age. Severe hypoglycemia (SH) and diabetic ketoacidosis (DKA) remain all too common complications of treatment, especially in older (SH) and younger patients (DKA). Insulin pump use increased slightly from enrollment (58–62%), and use of continuous glucose monitoring (CGM) did not change (7%). Although the T1D Exchange registry findings are not population based and could be biased, it is clear that there remains considerable room for improving outcomes of treatment of type 1 diabetes across all age-groups. Barriers to more effective use of current treatments need to be addressed and new therapies are needed to achieve optimal metabolic control in people with type 1 diabetes.

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Self-citation
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Self-citation
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Efeitos da restrição de carboidratos no manejo do diabetes mellitus: revisão de literatura científica
Campos, L. P., & Lobo, L. M. D. C. (2020) · DEMETRA Alimentação Nutrição & Saúde · doi:10.12957/demetra.2020.43534 · Cited by 3
The clinical characteristics and mutation search within monogenic diabetes genes in type 1 diabetes patients with long-term disease and preserved kidney function
Hohendorff, J., Kwiatkowska, M., Pisarczyk-Wiza, D., Ludwig‐Słomczyńska, A. H., Milcarek, M., Kapusta, P., Zapała, B., Kieć‐Wilk, B., Trznadel-Morawska, I., Szopa, M., et al. (2021) · Polskie Archiwum Medycyny Wewnętrznej · doi:10.20452/pamw.16143 · Cited by 3
More hypoglycemia not associated with increasing estimated adiposity in youth with type 1 diabetes
Sarteau, A. C., Kahkoska, A. R., Crandell, J., IGUDESMAN, D. A., Corbin, K. D., Kichler, J., Maahs, D. M., Muntis, F. R., Pratley, R. E., Seid, M., et al. (2022) · Pediatric Research · doi:10.1038/s41390-022-02129-1 · Cited by 3
Self-citation
Missed meal boluses and poorer glycemic control impact on neurocognitive function may be associated with white matter integrity in adolescents with type 1 diabetes
Litmanovitch, E., Geva, R., Leshem, A., Lezinger, M., Heyman, E., Gidron, M., Yarmolovsky, J., Sasson, E., Tal, S., & Rachmiel, M. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1141085 · Cited by 3
Environmental characteristics and type 1 diabetes: students' perspectives on diabetes management in college
Malova, E., & Harrison, T. R. (2023) · Frontiers in Communication · doi:10.3389/fcomm.2023.1208219 · Cited by 5
Prevalence of cardiovascular autonomic neuropathy in an admixed population of patients with type 1 diabetes. Lessons from a pioneer multicentre study in Brazil
Tannus, L. R. M., Pedrosa, H. C., Aguiar, C. H., Drummond, K. R. G., Pinheiro, A., Leal, F. S. L., Negrato, C. A., & Gomes, M. B. (2024) · Primary care diabetes · doi:10.1016/j.pcd.2024.08.001 · Cited by 4
Ketoacidosis in diabetes: Recognition and avoidance
MacArthur, C. (2015) · Practice Nursing · doi:10.12968/pnur.2015.26.8.393 · Cited by 3
Retrospective Analysis of Continuous Glucose Monitoring Data With the Surveillance Error Grid Supports Nonadjunctive Dosing Decisions
Welsh, J. B., Walker, T. C., & Price, D. A. (2017) · Journal of Diabetes Science and Technology · doi:10.1177/1932296817694180 · Cited by 3
Commentary Regarding Shapiro, “Nonadjunctive Use of Continuous Glucose Monitors for Insulin Dosing: Is It Safe?”
Price, D. A. (2017) · Journal of Diabetes Science and Technology · doi:10.1177/1932296817695341 · Cited by 3
The First Hybrid Closed-Loop Insulin Pump: Will It Meet Its Potential?
Hirsch, I. B. (2017) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2017.0045 · Cited by 3
Change in hemoglobin A1c one year following the 2014 American Diabetes Association guideline update
Alonso, G. T., Pyle, L. L., & Frohnert, B. I. (2017) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2017.03.033 · Cited by 3
Diabetes-related events in adolescents and young adults: opportunities for psychosocial interventions
LaBarbera, B., Dvorak, J., Zhang, Y., Jeter, K. M., Talsania, M., & Beck, J. K. (2019) · Psychology Health & Medicine · doi:10.1080/13548506.2019.1597976 · Cited by 3
Preference for Subcutaneously Administered Low-Dose Glucagon Versus Orally Administered Glucose for Treatment of Mild Hypoglycemia: A Prospective Survey Study
Tetzschner, R., Ranjan, A. G., Schmidt, S., & Nørgaard, K. (2019) · Diabetes Therapy · doi:10.1007/s13300-019-00696-x · Cited by 3
Comparison of several survey-based algorithms to ascertain type 1 diabetes among US adults with self-reported diabetes
Casagrande, S. S., Lessem, S. E., Orchard, T. J., Bullard, K. M., Geiss, L. S., Saydah, S., Menke, A., Imperatore, G., Rust, K., & Cowie, C. C. (2020) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2020-001917 · Cited by 3
“4 13 Given the various definitions used to classify type 1 diabetes using survey data and the lack of a gold standard, we examined the percentages of adults with diagnosed diabetes classified as having type 1 diabetes in the NHIS, using five primary and two supplementary algorithms, included for…”
Dental Treatment Effect on Blood Glucose Level Fluctuation in Type 1 Balanced Diabetic Children
Nassif, N., & Noueiri, B. (2021) · International Journal of Clinical Pediatric Dentistry · doi:10.5005/jp-journals-10005-1907 · Cited by 4
Use of continuous subcutaneous insulin infusion versus multiple daily injections in emerging adults with type 1 diabetes is associated with better clinical engagement but not glycaemic control
Chai, T. Y., Farrell, K., & Holmes-Walker, D. J. (2021) · Internal Medicine Journal · doi:10.1111/imj.15539 · Cited by 3
Development and validation of the self-management Barriers and Supports Evaluation for working-aged adults with type 1 diabetes mellitus
Planalp, E. M., Kliems, H., Chewning, B. A., Palta, M., LeCaire, T. J., Young, L., & COX, E. D. (2022) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2021-002583 · Cited by 3
Structured transition is associated with improved outcomes in diabetes
Harmer, M., Everitt, L. H., Parker, L., Davis, N. L., Connett, G. J., & Nagra, A. (2022) · Practical Diabetes · doi:10.1002/pdi.2375 · Cited by 3
Comparison of compliance and outcomes in adolescents with type 1 diabetes mellitus attending a co-located pediatric and transition diabetes service
Ali, N., Longson, J., Myszka, R., Park, K., Low, G. K. K., Leong, G. M., Bhurawala, H., & Liu, A. (2021) · Journal of Transition Medicine · doi:10.1515/jtm-2021-0003 · Cited by 4
“There are studies that have expressed the transfer to adult care may be accompanied by poor glycemic control and decreased clinic attendances [1, 2].”
Background
Restoring tolerance to β-cells in Type 1 diabetes: Current and emerging strategies
Carroll, K. R., & Katz, J. D. (2022) · Cellular Immunology · doi:10.1016/j.cellimm.2022.104593 · Cited by 4
Testing an Automated Approach to Identify Variation in Outcomes among Children with Type 1 Diabetes across Multiple Sites
Addison, J., Razzaghi, H., Bailey, L. C., Dickinson, K., Corathers, S. D., Hartley, D., Utidjian, L., Carle, A. C., Rhodes, E. T., Alonso, G. T., et al. (2022) · Pediatric Quality and Safety · doi:10.1097/pq9.0000000000000602 · Cited by 3
Mapping care provision for type 1 diabetes throughout Australia: a protocol for a mixed-method study
Carrigan, A., Lake, R., Zoungas, S., Huynh, T., Couper, J., Davis, E. A., Jones, T. W., Bloom, D. E., Braithwaite, J., & Zurynski, Y. A. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-067209 · Cited by 3
Intensified follow-up of patients with type 1 diabetes and poor glycaemic control: a multicentre quality improvement collaborative based on data from the Norwegian Diabetes Register for Adults
Madsen, T. V., Cooper, J. G., Carlsen, S., Løvaas, K. F., Rekdal, M., Igland, J., Sandberg, S., Ueland, G. Å., Iversen, M. M., & Sølvik, U. Ø. (2023) · BMJ Open Quality · doi:10.1136/bmjoq-2022-002099 · Cited by 3
Global stress and daily general and type 1 diabetes stressors and links to daily affect and diabetes outcomes during emerging adulthood
Berg, C. A., Tracy, E. L., Boggess, S. B., Butner, J., Loyola, M. D. R., & Wiebe, D. J. (2023) · Journal of Behavioral Medicine · doi:10.1007/s10865-023-00425-7 · Cited by 3
“Stress reactivity experienced in emerging adulthood together with challenges in keeping HbA1c on target (Miller et al., 2015) could place young adults at higher risk for long-term complications like blood vessel, kidney, and heart disease.”
Prevention of Type 1 Diabetes: Current Perspective
Pande, A. K., Dutta, D., & Singla, R. (2023) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/ijem.ijem_78_23 · Cited by 6
“[9] Therapies of T1D are becoming better and more efficacious with time, it still involves a lot of effort and expenditure (out of pocket in the case of India).”
Background
Group-based behaviour therapy improves self-care, glycaemic control and distress in adults with type 1 diabetes
Burkhardt, M. S., Pirri, C., Summers, M. A., Barrie, P., Aghabozorgi, M., Fegan, P. G., & Yeap, B. B. (2024) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2024.111095 · Cited by 4
Recent Improvements in Attainment of the Hemoglobin A1c Target of ≤7.0% Among Adults with Type 1 Diabetes in Ontario: A Retrospective Cohort Study
Weisman, A., Booth, G. L., Everett, K., & TOMLINSON, G. A. (2024) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2024.0017 · Cited by 5
Transition from Paediatric to Adult Diabetes Care in People with Type 1 Diabetes: An Online Survey from France
Eroukhmanoff, J., Schmit, C. B., Baron, S., Bahloul, A., Beltrand, J., Salamé, Z., Borot, S., Vale, F. D., Mosnier-Pudar, H., Nicolino, M. P., et al. (2024) · Diabetes Therapy · doi:10.1007/s13300-024-01630-6 · Cited by 3
Contributions of digital technologies for resilience capacity in a type 1 diabetes transition clinic: A qualitative study
Carrigan, A., Holmes-Walker, D. J., Farrell, K., Maguire, A., Lyng, H. B., Wiig, S., Guise, V., Long, J. C., Ellis, L. A., Wijekulasuriya, S., et al. (2024) · Applied Ergonomics · doi:10.1016/j.apergo.2024.104392 · Cited by 3
“Although individuals living with T1D typically understand these risks and the importance of maintaining glycemic control, registries show that less than 20% are able to achieve recommended glycemic targets (Holmes-Walker et al., 2023; Miller et al., 2015; Phelan et al., 2017).”
Influential
Protocol for Meal-time Administration of Exenatide for Glycaemic Control in Type 1 Diabetes Cases (The MAG1C trial): a randomised, double-blinded, placebo-controlled trial
Johansen, N. J., Dejgaard, T. F., Lund, A., Vilsbøll, T., Andersen, H. U., & Knop, F. K. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-021861 · Cited by 3
‘La Vida Normal’: Young people adapting to Type 1 diabetes in Bolivia
Souris, K. J., Gonzales, M. D. C. C., Barrington, C., Klatman, E. L., Anderson, B. J., Duarte, E. D. R., Middlehurst, A. C., Nostas, M. C., & Ogle, G. D. (2019) · Chronic Illness · doi:10.1177/1742395319843172 · Cited by 4
“Other studies have supported the resentment, anger, and depression that often accompany diagnosis and life with T1D, especially for young people.31–33 Emotional distress and elevated glycaemia can operate in a vicious cycle, each exacerbating the other.34,35 Additionally, experienced and perceived stigma has been asso…”
Result
Pediatric type 1 diabetes
O’Donnell, H. K., & Driscoll, K. A. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-816000-8.00003-7 · Cited by 4
Development and Validity Testing of a Type 1 Diabetes Resource for 10-19-Years Old Adolescents in China
Zhao, X., Hilton, A., Watson, R. A., & Chen, Y. (2021) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2021.03.029 · Cited by 3
The Economic Evaluation of Team Clinic—Group Approach to a Care Model of Early Adolescents With Type 1 Diabetes
Wan, W., Nathan, A. G., Reid, M. W., Majidi, S., Fogel, J. L., Raymond, J. K., & Huang, E. S. (2022) · Journal of Pediatric Health Care · doi:10.1016/j.pedhc.2022.05.007 · Cited by 3
Sensor Life and Overnight Closed Loop: A Randomized Clinical Trial
Tauschmann, M., Allen, J. M., Wilinska, M. E., Ruan, Y., Thabit, H., Acerini, C. L., Dunger, D. B., & Hovorka, R. (2016) · Journal of Diabetes Science and Technology · doi:10.1177/1932296816678631 · Cited by 3
“CGM is becoming increasingly popular in people with type 1 diabetes across all age-groups.(1) Clinical benefits, particularly in combination with insulin pump therapy, are conditioned on good adherence.”
Background

Authors: Miller, K. M., Foster, N. C., Beck, R. W., Bergenstal, R. M., DuBose, S. N., DiMeglio, L. A., Maahs, D. M., & Tamborlane, W. V.
Affiliations: Jaeb Center for Health Research (US)
Park Nicollet Health Services (US)
Indiana University School of Medicine (US)
Barbara Davis Center for Childhood Diabetes, Aurora, CO
Yale University (US)
Corresponding author: Miller, Kellee M.
ORCID: Miller, Kellee M.
Foster, Nicole C.
Beck, Roy W.
Bergenstal, Richard M.
DuBose, Stephanie N.
DiMeglio, Linda A.
Maahs, David M.
Tamborlane, William V.
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 2015-05-12
Volume: 38
Issue: 6
Pages: 971-978
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/dc15-0078
OpenAlex: W2098570086
Cited by: 1,254
References: 25
Citations by year: 2026: 35 · 2025: 55 · 2024: 64 · 2023: 88 · 2022: 81 · 2021: 134 · 2020: 157 · 2019: 198 · 2018: 176 · 2017: 138 · 2016: 108 · 2015: 19
FWCI: 127.79
Type: journal article
Language: en
Open access: closed
Licence: www.diabetesjournals.org/site/license (vor, 203 d)
Locations: Diabetes Care (publishedVersion)
PubMed (publishedVersion)
Funders: Leona M. and Harry B. Helmsley Charitable Trust
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
Keywords: type 1 diabetes, glycemic control, HbA1c, severe hypoglycemia, diabetic ketoacidosis, insulin pump therapy, continuous glucose monitoring, diabetes technology, age trends
MeSH terms: Adolescent, Adult, Aged, Child, Child, Preschool, Diabetes Mellitus, Type 1, Health Services Needs and Demand, Glycated Hemoglobin, Humans, Insulin Infusion Systems, Male, Middle Aged, Registries, United States, Blood Glucose Self-Monitoring, Comorbidity, Diabetic Ketoacidosis, Young Adult

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Current State of Type 1 Diabetes Treatment in the U.S.: Updated Data From the T1D Exchange Clinic Registry

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