Differences in the Management of Type 1 Diabetes Among Adults Under Excellent Control Compared With Those Under Poor Control in the T1D Exchange Clinic Registry
- Jill H. Simmons, MD1,
- Vincent Chen, PHD2,
- Kellee M. Miller, MPH2⇑,
- Janet B. McGill, MD3,
- Richard M. Bergenstal, MD4,
- Robin S. Goland, MD5,
- David M. Harlan, MD6,
- Joseph F. Largay, PA7,
- Elaine M. Massaro, MS, RN, CDE8,
- Roy W. Beck, MD, PHD2,
- for the T1D Exchange Clinic Network*
- 1Vanderbilt University Medical Center, Nashville, Tennessee
- 2Jaeb Center for Health Research, Tampa, Florida
- 3Washington University, St. Louis, Missouri
- 4Park Nicollet International Diabetes Center, Minneapolis, Minnesota
- 5Naomi Berrie Diabetes Center, Columbia University, New York, New York
- 6University of Massachusetts Medical School, Worcester, Massachusetts
- 7University of North Carolina, Chapel Hill, North Carolina
- 8Northwestern University School of Medicine, Chicago, Illinois
- Corresponding author: Kellee M. Miller, .
OBJECTIVE Optimizing glycemic control in type 1 diabetes is important to minimize the risk of complications. We used the large T1D Exchange Clinic Registry database to identify characteristics and diabetes management techniques in adults with type 1 diabetes, differentiating those under excellent glycemic control from those with poorer control.
RESEARCH DESIGN AND METHODS The cross-sectional analysis included 627 participants with HbA1c <6.5% (excellent control) and 1,267 with HbA1c ≥8.5% (fair/poor control) at enrollment who were ≥26 years of age (mean ± SD 45.9 ± 13.2 years), were not using continuous glucose monitoring, and had type 1 diabetes for ≥2 years (22.8 ± 13.0 years).
RESULTS Compared with the fair/poor control group, participants in the excellent control group had higher socioeconomic status, were more likely to be older and married, were less likely to be overweight, were more likely to exercise frequently, and had lower total daily insulin dose per kilogram (P < 0.0001 for each). Excellent control was associated with more frequent self-monitoring of blood glucose (SMBG), giving mealtime boluses before a meal rather than at the time of or after a meal, performing SMBG before giving a bolus, and missing an insulin dose less frequently (P < 0.0001 for each). Frequency of severe hypoglycemia was similar between groups, whereas diabetic ketoacidosis was more common in the fair/poor control group.
CONCLUSIONS Diabetes self-management related to insulin delivery, glucose monitoring, and lifestyle tends to differ among adults with type 1 diabetes under excellent control compared with those under poorer control. Future studies should focus on modifying diabetes management skills in adult type 1 diabetes patients with suboptimal glycemic control.
- Received December 20, 2012.
- Accepted June 6, 2013.
- © 2013 by the American Diabetes Association.
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