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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
The T1D exchange clinic registry
Beck, R. W., Tamborlane, W. V., Bergenstal, R. M., Miller, K. M., DuBose, S. N., Hall, C. A., & for the T1D Exchange Clinic Network (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2012-1561 · Cited by 456
Self-citation
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BackgroundInfluential
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Background
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Background
β-cell replenishment: Possible curative approaches for diabetes mellitus
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Self-citation
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Result
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Result
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BackgroundInfluential
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Background
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Influential
FREE: A randomized controlled feasibility trial of a cognitive behavioral therapy and technology-assisted intervention to reduce fear of hypoglycemia in young adults with type 1 diabetes
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Background
Implementation and Preliminary Feasibility of an Individualized, Supportive Approach to Behavioral Care for Parents of Young Children Newly Diagnosed With Type 1 Diabetes
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Skog, O., & Korsgren, O. (2017) · Diabetes Obesity and Metabolism · doi:10.1111/dom.13144 · Cited by 14
A longitudinal, observational study examining the relationships of patient satisfaction with services and mental well‐being to their clinical course in young people with Type 1 diabetes mellitus during transition from child to adult health services
Gray, S. G., Cheetham, T. D., McConachie, H., Mann, K. D., Parr, J. R., Pearce, M. S., Colver, A. F., & the Transition Collaborative Group (2018) · Diabetic Medicine · doi:10.1111/dme.13698 · Cited by 13
Interventions using pediatric diabetes registry data for quality improvement: A systematic review
Burry, E., Ivers, N. M., Mahmud, F. H., & Shulman, R. M. (2018) · Pediatric Diabetes · doi:10.1111/pedi.12699 · Cited by 13
“Interventions that target the health system and patients should be more extensively studied in pediatric populations because these have been shown to be particularly effective in populations with sub-optimal control.(5,18) Some studies showed improvements in structure or process outcomes, such as improved documentatio…”
Background
Stressful Life Events in Young Adults With Type 1 Diabetes in the U.S. T1D Exchange Clinic Registry
Joiner, K. L., Holland, M. L., & Grey, M. J. (2018) · Journal of Nursing Scholarship · doi:10.1111/jnu.12428 · Cited by 17
“Evidence indicates that the mean A1c level among young adults (18–25 years old) with T1D in the United States is 8.7% (Miller et al., 2015).”
Influential
Earlier puberty in boys with type 1 diabetes mellitus compared to a simultaneously recruited group of control adolescents
Gaete, X., V, Vivanco, M., López, P. V., Rocha, A., Sepúlveda, C., & Ethel Codner, D. (2018) · Pediatric Diabetes · doi:10.1111/pedi.12811 · Cited by 13
“2% at the age of 10 years old to 9% at the age of 15 years old, which is the puberty period for boys.(23) Moreover, a recent longitudinal assessment showed that a fifth of all adolescents exhibit significant changes in the trajectory of metabolic control.”
Background
Parental assessment of disordered eating behaviors in their children with type 1 diabetes: A controlled study
Troncone, A., Cascella, C., Chianese, A., Zanfardino, A., Confetto, S., Piscopo, A., & Iafusco, D. (2019) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2019.02.003 · Cited by 13
Feasibility Studies of an Insulin-Only Bionic Pancreas in a Home-Use Setting
Ekhlaspour, L., Nally, L. M., El-Khatib, F. H., Ly, T. T., Clinton, P. K., Frank, E., Tanenbaum, M. L., Hanes, S. J., SELAGAMSETTY, R., Hood, K. K., et al. (2019) · Journal of Diabetes Science and Technology · doi:10.1177/1932296819872225 · Cited by 13
β cell responses to inflammation
Usmani‐Brown, S., Perdigoto, A. L., Lavoie, N., Clark, P. L., Korah, M. M., Rui, J., Betancur, G., & Herold, K. C. (2019) · Molecular Metabolism · doi:10.1016/j.molmet.2019.06.013 · Cited by 14
A cognitive behavioral therapy intervention to reduce fear of hypoglycemia in young adults with type 1 diabetes (FREE): study protocol for a randomized controlled trial
Martyn-Nemeth, P. A., Duffecy, J. L., Quinn, L., Park, C., Mihailescu, D. V., & Penckofer, S. M. (2019) · Trials · doi:10.1186/s13063-019-3876-4 · Cited by 13
Glycaemic control across the lifespan in a cohort of New Zealand patients with type 1 diabetes mellitus
Chepulis, L. M., Tamatea, J. A. U., Wang, C., Goldsmith, J., Mayo, C., & Paul, R. G. (2020) · Internal Medicine Journal · doi:10.1111/imj.14816 · Cited by 13
Overweight and obese children with optimal control in the T1D Exchange Registry: How are they different from lean children with optimal control?
Flokas, M. E., Zeymo, A., Méte, M., Anhalt, H., Rother, K. I., & Gourgari, E. (2019) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2019.107513 · Cited by 14
The association of low‐density lipoprotein cholesterol with elevated arterial stiffness in adolescents and young adults with type 1 and type 2 diabetes: The SEARCH for Diabetes in Youth study
Gourgari, E., Stafford, J. M., D'Agostino, R., Dolan, L. M., Lawrence, J. M., Marcovina, S. M., Merjaneh, L., Mottl, A. K., SHAH, A. S., & Dabelea, D. (2020) · Pediatric Diabetes · doi:10.1111/pedi.13021 · Cited by 13
“It is estimated that only 17% of adolescents with T1D can achieve optimal glycemic control.(1,2,5) Also, 34% of youth with T1D are obese or overweight while 90% of patients with T2D are overweight or obese.”
Background
The impact of insulin pump therapy compared to multiple daily injections on complications and mortality in type 1 diabetes: A real‐world retrospective cohort study
Haughton, S., Riley, D. R. J., Berry, S. A., Arshad, M. F., Eleftheriadou, A., Anson, M., Yap, Y. W., Cuthbertson, D. J., Malik, R. A., Azmi, S., et al. (2025) · Diabetes Obesity and Metabolism · doi:10.1111/dom.16455 · Cited by 14
Association of ADHD symptoms with type 2 diabetes and cardiovascular comorbidities in adults receiving outpatient diabetes care
Dehnavi, A. Z., Zhang‐James, Y., Draytsel, D. Y., Carguello, B., Faraone, S. V., & Weinstock, R. S. (2023) · Journal of Clinical & Translational Endocrinology · doi:10.1016/j.jcte.2023.100318 · Cited by 12
Immune Evasion in Stem Cell-Based Diabetes Therapy—Current Strategies and Their Application in Clinical Trials
Mu-u-min, R., Diané, A., Allouch, A., & Al-Siddiqi, H. (2025) · Biomedicines · doi:10.3390/biomedicines13020383 · Cited by 13
“The current approach to treating T1DM involves managing glycemia through daily insulin supplementation, administered either via insulin injections or insulin pumps equipped with integrated glucose monitors [13,14].”
Situación clínica de una cohorte de pacientes con diabetes tipo 1 más de 2 décadas después del inicio. Resultados de un programa específico de seguimiento en una unidad de referencia
Amor, A. J., Cabrer, M., Giménez, M., Vinagre, I., Ortega, E., & Conget, I. (2016) · Endocrinología y Nutrición · doi:10.1016/j.endonu.2016.03.008 · Cited by 12
Beta-cell replacement therapy
Dunn, T. B., Kirchner, V. A., & Bellin, M. D. (2015) · Current Opinion in Organ Transplantation · doi:10.1097/mot.0000000000000245 · Cited by 12
An Effective Diabetic Ketoacidosis Prevention Intervention in Children With Type 1 Diabetes
Vitale, R. J., Card, C. E., Lichtman, J. H., Weyman, K., Michaud, C., Sikes, K. A., Tamborlane, W. V., & WEINZIMER, S. A. (2018) · SAGE Open Nursing · doi:10.1177/2377960818804742 · Cited by 12
“Diabetic ketoacidosis (DKA) is a leading cause of morbidity and mortality in young people with type 1 diabetes (T1D; Miller et al., 2015), being responsible for approximately 50% of the deaths in people with diabetes under 24 years old (Bismuth & Laffel, 2007; Laffel, 2000), and over 75% of deaths…”
Self-citation
Perceptions and experiences of living with type 1 diabetes among Latino adolescents and parents with limited English proficiency
Joiner, K. L., DeJonckheere, M. J., Whittemore, R., & Grey, M. J. (2020) · Research in Nursing & Health · doi:10.1002/nur.22019 · Cited by 21
Pharmacological therapies to address obesity in type 1 diabetes
Casu, A., Bilal, A., & Pratley, R. E. (2020) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0000000000000555 · Cited by 13
“In the T1D Exchange Registry, the prevalence of overweight and obesity increases with age, reaching 68% in patients above the age of 50 [7].”
Background
Sleep, self‐management, neurocognitive function, and glycemia in emerging adults with Type 1 diabetes mellitus: A research protocol
Griggs, S. A., Redeker, N. S., Crawford, S. L., & Grey, M. J. (2020) · Research in Nursing & Health · doi:10.1002/nur.22051 · Cited by 12
“CGM use increased in this population nationally from 7% in 2010–2012 to 30% in 2016–2018 (Foster et al., 2019; Miller et al., 2015).”
Background
The clock is ticking: Parental stress around emerging adulthood for adolescents with type 1 diabetes
Yi‐Frazier, J. P., Senturia, K., Wright, D. R., Lind, C. D., & Malik, F. S. (2021) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2021.07.012 · Cited by 14
Insulin Restriction, Emotion Dysregulation, and Depressive Symptoms in Late Adolescents with Diabetes
Beam, A. B., Wiebe, D. J., & Berg, C. A. (2021) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsab042 · Cited by 14
“Similar to national samples of youth with type 1 diabetes (Miller et al., 2015), most participants were nonHispanic White (75%), with 14% identifying as Hispanic/Latino.”
BackgroundResult
Uncontrolled type 1 diabetes among Egyptian adolescents; risk determinants and clinical outcomes
Elhabashy, S. A., Sherif, E. M., Salah, N. Y., Elkader, M. A. E. A., & Youssef, D. A. H. (2022) · Diabetes Epidemiology and Management · doi:10.1016/j.deman.2022.100051 · Cited by 12
Real-World Application of Insulin Pump Therapy Among Patients With Type 1 Diabetes in China: A Cross-Sectional Study
Huo, L., Deng, W., Lan, L., Li, W., Shaw, J. E., Magliano, D. J., & Ji, L. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.891718 · Cited by 12
No Summer Vacation From Diabetes: Glycemic Control in Pediatric Participants in the T1D Exchange Registry Based on Time of Year
Sherr, J. L., Boyle, C. T., Miller, K. M., Beck, R. W., & Tamborlane, W. V. (2016) · Diabetes Care · doi:10.2337/dc16-1522 · Cited by 12
Self-citation
Effect of 6 months hybrid closed-loop insulin delivery in young people with type 1 diabetes: a randomised controlled trial protocol
de Bock, M. I., McAuley, S. A., Abraham, M. B., Smith, G. J., Nicholas, J. A., Ambler, G. R., Cameron, F. J., Fairchild, J. M., King, B. R., Geelhoed, E. A., et al. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-020275 · Cited by 13
“However, despite improvements in diabetes education, insulin pharmacology, glucose monitoring and insulin delivery devices, fewer than a third of patients reach haemoglobin A1c (HbA1c) targets set by international guidelines.(6) Further, adolescence and young adulthood are particularly highrisk age groups, during whic…”
Background
Efficacy and Clinical Value of Liraglutide for Treatment of Diabetes Mellitus Complicated by Non-Alcoholic Fatty Liver Disease
Zhang, Z., Qi, Y., Kong, W., Jin, Q., Wang, X., Dong, Y., Wang, Y., & Li, H. (2018) · Medical Science Monitor · doi:10.12659/msm.911062 · Cited by 14
Performance-based and questionnaire measures of executive function in adolescents with type 1 diabetes
Hamburger, E., Lyttle, M., Compas, B. E., & Jaser, S. S. (2019) · Journal of Behavioral Medicine · doi:10.1007/s10865-019-00027-2 · Cited by 13
Disturbed eating, illness perceptions, and coping among adults with type 1 diabetes on intensified insulin treatment, and their associations with metabolic control
Wisting, L., Rø, A., Skrivarhaug, T., Dahl‐Jørgensen, K., & Rø, Ø. (2019) · Journal of Health Psychology · doi:10.1177/1359105319840688 · Cited by 14
“Yet, most individuals with T1D do not reach the international treatment target of HbA1c <7 percent (53 mmol/mol) (Løvaas et al., 2017; Miller et al., 2015).”
Background
Beyond type 2 diabetes: sodium glucose co‐transporter‐inhibition in type 1 diabetes
Biester, T., Kordonouri, O., & Danne, T. (2019) · Diabetes Obesity and Metabolism · doi:10.1111/dom.13659 · Cited by 12
“Recent data show that most patients with T1D, even those in industrial nations, fail to reach their treatment goals.(5,6) New technologies, such as sensor augmented pump therapy(7,8) and closed-loop insulin delivery approaches(9,10) are being developed to Abbreviations: BHB, β-hydroxybutyrate; CGM, continuous glucose…”
Background
Flash Continuous Glucose Monitoring: Implications for Use of Continuous Data in Daily Diabetes Management
Hirsch, I. B., Nardacci, E., & Verderese, C. A. (2019) · Diabetes Spectrum · doi:10.2337/ds18-0059 · Cited by 12
Type 1 diabetes self‐management behaviors among emerging adults: Racial/ethnic differences
Butler, A. M., Weller, B. E., Rodgers, C. R. R., & Teasdale, A. E. (2020) · Pediatric Diabetes · doi:10.1111/pedi.13061 · Cited by 12
Atrial fibrillation risk in patients suffering from type I diabetes mellitus. A review of clinical and experimental evidence
Vrachatis, D. A., Papathanasiou, K. A., Kossyvakis, C., Giotaki, S. G., Raisakis, K., Iliodromitis, K. E., Reimers, B., Stefanini, G. G., CLEMAN, M. W., Sianos, G., et al. (2021) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2021.108724 · Cited by 11
Impact of high‐risk glycemic control on habitual sleep patterns and sleep quality among youth (13–20 years) with type 1 diabetes mellitus compared to controls without diabetes
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Predicting Success with a First-Generation Hybrid Closed-Loop Artificial Pancreas System Among Children, Adolescents, and Young Adults with Type 1 Diabetes: A Model Development and Validation Study
Forlenza, G. P., Vigers, T., Berget, C., Messer, L. H., Lal, R., Basina, M., Maahs, D. M., Hood, K. K., Buckingham, B. A., Wilson, D. M., et al. (2021) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2021.0326 · Cited by 12
Self-citation
Clinical potential of fasting in type 1 diabetes
Varady, K. A., Runchey, M.-C., Reutrakul, S., Vidmar, A. P., & Chow, L. S. (2024) · Trends in Endocrinology & Metabolism · doi:10.1016/j.tem.2024.01.007 · Cited by 12
Type 1 diabetes in Laos, 2016–2021
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Frequency and Causes of Nocturnal Alarms in Youth and Young Adults With Type 1 Diabetes Using a First-Generation Hybrid Closed-Loop System
Cobry, E. C., Vigers, T., Berget, C., Messer, L. H., Wadwa, R. P., Pyle, L. L., & Forlenza, G. P. (2023) · Diabetes Spectrum · doi:10.2337/ds23-0003 · Cited by 11
Impact of continuous glucose monitoring on everyday life of young children with type 1 diabetes and their parents: An evaluation of 114 families
Aouchiche, K., Bernoux, D., Baechler-Sadoul, E., Haine, E., Joubert, F., Epstein, S., Galon-Faure, N., Dalla‐Vale, F., Combe, J.-C., Samper, M., et al. (2023) · Primary care diabetes · doi:10.1016/j.pcd.2023.11.002 · Cited by 11

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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