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Current State of Type 1 Diabetes Treatment in the U.S.: Updated Data From the T1D Exchange Clinic Registry
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-citationThe T1D exchange clinic registry
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“Additionally, whereas more advanced technology is commonplace in high income settings, with the uptake of insulin pumps exceeding 60% in the US (Miller et al., 2015), many children in Kenya struggle to afford the basics of needles and insulin.”
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Who Should Be Considered for Islet Transplantation Alone?
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InfluentialThe Development of Immunotherapy Strategies for the Treatment of Type 1 Diabetes
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“Despite continuing improvements in insulin therapy, the majority of patients fail to adequately control their glucose homeostasis (1), resulting in both short-term (hypoglycemia) and long term (nephropathy, retinopathy, neuropathy, and others) complications.”
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“0%.(4) Persistent hyperglycemia increases the risk of developing acute and chronic diabetic complications(1,3) and thus increases the economic burden of diabetes.”
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“Research has found that diabetes management is particularly difficult during adolescence, a developmental period associated with substantially deteriorating glycemic control.(3,4) However, effective management of T1D should not be based solely on glycemic control or specific management behaviors.”
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“0%.[73] Some of the limitations of insulin therapy are large glucose fluctuations (with risk of hypoglycemia) and weight gain.”
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“To adapt this framework to address the needs of the targeted population, our research team conducted a qualitative needs assessment amongst young adults with both T1D and T2D (23, 24), and developed and validated an intervention manual among a small sample of young adults with diabetes (25).”
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Candidate Selection for Hybrid Closed Loop Systems
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“In further large multicenter studies, HbA1c was also reported to increase with higher age group across childhood.(7,9,11) These studies did however not use repeated measurements, but categorizations or means of HbA1c in the analyses.”
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“Achieving glycemic objectives recommended by scientific societies is accomplished in less than a third of patients with T1D [2].”
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“than 1% of children in the United States who require insulin MDI or CSII treatment for type 1 diabetes still use regular human insulin as short-acting insulin (117).”
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Diabetes-specific family conflict: Informant discrepancies and the impact of parental factors.
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“…completed by parents, and adolescents’ shift toward independence and the associated increase in responsibility for diabetes management is often linked with less optimal glycemic control, with only 17% of adolescents meeting the ADA’s recommendation for glycemic control (Miller et al., 2015).”
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Cost-effectiveness of Shared Telemedicine Appointments in Young Adults With T1D: CoYoT1 Trial
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Adjunct therapies in treatment of type 1 diabetes
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“The weight gain caused by insulin use could further contribute to the increasing overweight and obesity trends observed in the T1D population in the United States and elsewhere.(1,4,5)”
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Gingival crevicular fluid biomarkers in type 1 diabetes mellitus: A case–control study
Sereti, M., Roy, M., Zekeridou, A., Gastaldi, G., & Giannopoulou, C. (2020) · Clinical and Experimental Dental Research · doi:10.1002/cre2.351 · Cited by 20
“…with T1D and aged between <4 and >75 years old, showed that HbA1c levels can vary considerably with age, with higher levels during childhood and adolescence, a gradual decline until 30 years of age followed by a plateau, and again a modest drop after 65 years of age (Miller et al., 2015).”
BackgroundContinuous Glucose Monitoring in Adolescent, Young Adult, and Older Patients With Type 1 Diabetes
Agarwal, S., & Cappola, A. R. (2020) · JAMA · doi:10.1001/jama.2020.7058 · Cited by 19
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Addressing Unmet Medical Needs in Type 1 Diabetes: A Review of Drugs Under Development
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Bisno, D. I., Reid, M. W., Pyatak, E. A., Garcia, J. F., Salcedo-Rodriguez, E., Sanchez, A. T., Fox, D. S., Hiyari, S., Fogel, J. L., Marshall, I., et al. (2023) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2023.0199 · Cited by 21
“6 Less than one in five AYA have HbA1c levels consistent with recommendations from the American Diabetes Association (ADA), 7 suggesting that current models of care do not meet the needs of most AYA with T1D.”
Continuous glucose monitoring: a systematic review of sensor systems and prospects
Ray, P. P. (2018) · Sensor Review · doi:10.1108/sr-12-2017-0268 · Cited by 18
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“2% [1], which is also the common age of college transition.”
BackgroundBiester, T., Schwandt, A., Heidtmann, B., Rami-Merhar, B. M., Haak, T., Festa, A., Kostow, S., Müller, A., Mönkemöller, K., Danne, T., et al. (2021) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2020.0675 · Cited by 19
“This finding of low SH (coma) is also consistent with previous research in which a significantly lower frequency of SH with insulin pump use has been observed compared with MDI.”
InfluentialFelix dies natalis, insulin… ceterum autem censeo “beta is better”
Piemonti, L. (2021) · Acta Diabetologica · doi:10.1007/s00592-021-01737-3 · Cited by 18
State of Type 1 Diabetes Care in the United States in 2016–2018 from T1D Exchange Registry Data
Rodbard, D. (2019) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2019.0008 · Cited by 18
DeLacey, S. E., Papadakis, J. L., James, S., Cudizio, L., Ng, S. M., Lyons, S. K., Maruthur, N. M., Araszkiewicz, A., Gomber, A., Snoek, F. J., et al. (2025) · Current Diabetes Reports · doi:10.1007/s11892-025-01578-2 · Cited by 20
Forbes, J. M., McCarthy, D. A., Kassianos, A. J., Baskerville, T., Fotheringham, A. K., Giuliani, K. T. K., Grivei, A., Murphy, A. J., Flynn, M., Sullivan, M. A., et al. (2021) · Diabetes · doi:10.2337/db20-1081 · Cited by 17
Zhao, X., Huang, H., & Zheng, S. (2021) · Worldviews on Evidence-Based Nursing · doi:10.1111/wvn.12511 · Cited by 20
BISKUPIAK, J. E., Ramos, M., Levy, C. J., Forlenza, G. P., Hopley, C. D. J., Boyd, J., Swift, D., Lamotte, M., & Brixner, D. I. (2023) · Journal of Managed Care & Specialty Pharmacy · doi:10.18553/jmcp.2023.22331 · Cited by 18
Design Considerations for Artificial Pancreas Pivotal Studies
Russell, S. J., & Beck, R. W. (2015) · Diabetes Care · doi:10.2337/dc15-2449 · Cited by 17
Self-citationGalderisi, A., Tremblay, E. S., & Cengiz, E. (2017) · Current Diabetes Reports · doi:10.1007/s11892-017-0944-6 · Cited by 18
Bonato, L., Taleb, N., Gingras, V., Messier, V., Gobeil, F., Ménard, J., Ardilouze, J., & RABASA-LHORET, R. P. R. (2018) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2018.0110 · Cited by 19
“4,5 6–8 Moreover, the insulin pump is an important component of the external artificial pancreas, which combines CSII with a glucose sensor and a dosing algorithm.”
Long-Term Safety of α-1 Antitrypsin Therapy in Children and Adolescents with Type 1 Diabetes
Brener, A., Lebenthal, Y., Interator, H., Horesh, O., Leshem, A., Weintrob, N., Loewenthal, N., Shalitin, S., & Rachmiel, M. (2018) · Immunotherapy · doi:10.2217/imt-2018-0047 · Cited by 17
Baker, A. C., Wiebe, D. J., Kelly, C. S., Munion, A. K., Butner, J., Swinyard, M. T., Murray, M. A., & Berg, C. A. (2019) · Journal of Behavioral Medicine · doi:10.1007/s10865-019-00012-9 · Cited by 19
“…time when young people are managing diabetes more independently from parents (Hanna et al., 2013), and experience changing relationships with providers as they transfer from long-standing relationships with pediatric providers to new relationships with adult care providers (Monaghan et al., 2015).”
InfluentialGallagher, K. A. S., DeSalvo, D. J., Gregory, J. M., & Hilliard, M. E. (2019) · Current Diabetes Reports · doi:10.1007/s11892-019-1153-2 · Cited by 20
Styles, S. E., Gray, A. R., de Bock, M. I., Wiltshire, E. J., Galland, B. C., Tomlinson, P. A., Rayns, J. A., MacKenzie, K. E., & Wheeler, B. J. (2019) · BMC Endocrine Disorders · doi:10.1186/s12902-019-0378-z · Cited by 17
“Adolescence is a high-risk period where glycaemic control is at its worst [18], treatment adherence is a particular challenge [19] and the strain of self-management takes a toll on adolescents’ and their parents’ quality of life [20].”
BackgroundKenowitz, J., Hoogendoorn, C. J., COMMISSARIAT, P. V., & Gonzalez, J. S. (2019) · Diabetic Medicine · doi:10.1111/dme.14056 · Cited by 21
Nefs, G., Bazelmans, E., Marsman, D. E., Snellen, N., Tack, C. J., & de Galan, B. E. (2019) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2019.107910 · Cited by 17
Nagel, K. E., Dearth‐Wesley, T., Herman, A. N., Smith, H. G., Gandica, R., Golden, L., Weil, H., & Whitaker, R. C. (2020) · Pediatric Diabetes · doi:10.1111/pedi.13000 · Cited by 17
Xu, Y., Xu, L., Zhao, W., Li, Q., Li, M., Lu, W., Zeng, H., Yan, J., Yang, D., Wu, W., et al. (2021) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s299070 · Cited by 17
Dunger, D. B. (2016) · Diabetic Medicine · doi:10.1111/dme.13299 · Cited by 18
Polsky, S., GIORDANO, D. A., Voelmle, M. K., Garcetti, R., & Garg, S. K. (2016) · Postgraduate Medicine · doi:10.1080/00325481.2016.1159910 · Cited by 16
“issue, or pump malfunction),[20,21] however data supports the contrary.[22,23] Thus, anyone using CSII should have a”
ResultGoethals, E. R., Volkening, L. K., TINSLEY, L. J., & Laffel, L. M. (2020) · Diabetic Medicine · doi:10.1111/dme.14507 · Cited by 18
Choe, J., Won, S., Choe, Y., Park, S. H., Lee, Y. J., Lee, J. E., Lee, Y. A., Lim, H. H., Yoo, J. H., Lee, S. Y., et al. (2021) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2021.0274 · Cited by 16
A perspective on treating type 1 diabetes mellitus before insulin is needed
Tatović, D., Narendran, P., & Dayan, C. M. (2023) · Nature Reviews Endocrinology · doi:10.1038/s41574-023-00816-5 · Cited by 22
Mu-u-min, R., Diané, A., Allouch, A., & Al-Siddiqi, H. (2023) · Biomedicines · doi:10.3390/biomedicines11061577 · Cited by 17
Emami, A., Willinska, M. E., Thabit, H., Leelarathna, L., Hartnell, S., Dellweg, S., Benesch, C., Mader, J. K., Holzer, M., Kojzar, H., et al. (2017) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2016.0307 · Cited by 16
Jaser, S. S., Lord, J. H., Savin, K. L., Gruhn, M. A., & Rumburg, T. M. (2018) · Clinical Practice in Pediatric Psychology · doi:10.1037/cpp0000220 · Cited by 17
“…no t to be di ss em in at ed br oa dl y. Clinical Practice in Pediatric Psychology © 2018 American Psychological Association 2018, Vol. 6, No. 1, 19–30 2169-4826/18/$12.00 http://dx.doi.org/10.1037/cpp0000220 19 17% of adolescents were meeting recommended treatment targets (Miller et al., 2015).”
InfluentialExperiences and real life management of insulin pump therapy in adults with type 1 diabetes
Quirós, C., Jansà, M., Viñals, C., Giménez, M., Roca, D., Escarrabill, J., Garcia, F., Pérez, S., & Conget, I. (2018) · Endocrinología Diabetes y Nutrición · doi:10.1016/j.endinu.2018.05.017 · Cited by 16
“This finding may indicates that CSII more active self-adjustments could be beneficial in terms of metabolic control.11,13 Regarding efficacy, on average, an HbA1c of 7.7%, with a value 7.5% in 43% of patients and 11% of SMBG 70 mg/dl could be considered satisfactory in comparison with previous reports of patients with…”
ResultInfluentialGuilmin‐Crépon, S., Carel, J., Schroedt, J., Sulmont, V., Salmon-Musial, A. S., Tallec, C. L., Coutant, R., Dalla‐Vale, F., Stuckens, C., Bony-Trifunovic, H., et al. (2019) · Pediatric Diabetes · doi:10.1111/pedi.12820 · Cited by 17
Metadata
- 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
- 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
- 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
- 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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