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Diabetes Care. 2019 Sep 23. pii: dc190830. doi: 10.2337/dc19-0830. [Epub ahead of print]

Incidences of Severe Hypoglycemia and Diabetic Ketoacidosis and Prevalence of Microvascular Complications Stratified by Age and Glycemic Control in U.S. Adult Patients With Type 1 Diabetes: A Real-World Study.

Author information

1
University of California San Diego, San Diego, CA.
2
Sanofi, Bridgewater, NJ liz.zhou@sanofi.com.
3
Evidera, London, U.K.
4
Sanofi, Bridgewater, NJ.
5
Evidera, Waltham, MA.
6
Jaeb Center for Health Research, Tampa, FL.
7
Veterans Affairs Medical Center, University of California San Diego, San Diego, CA.

Abstract

OBJECTIVE:

To assess the burden of disease for adults with type 1 diabetes in a U.S. electronic health record database by evaluating acute and microvascular complications stratified by age and glycemic control.

RESEARCH DESIGN AND METHODS:

This is a retrospective observational study of adults with type 1 diabetes (1 July 2014-30 June 2016) classified using a validated algorithm, with disease duration ≥24 months and, during a 12-month baseline period, not pregnant and having one or more insulin prescriptions and one or more HbA1c measurements. Demographic characteristics, acute complications (severe hypoglycemia [SH], diabetic ketoacidosis [DKA]), and microvascular complications (neuropathy, nephropathy, retinopathy) were stratified by age (18-25, 26-49, 50-64, ≥65 years) and glycemic control (HbA1c <7%, 7 to <9%, ≥9%).

RESULTS:

Of 31,430 patients, ∼20% had HbA1c <7%. Older patients had lower HbA1c values than younger patients (P < 0.001). Patients with poor glycemic control had the highest annual incidence of SH (4.2%, 4.0%, and 8.3%) and DKA (1.3%, 2.8%, and 15.8%) for HbA1c <7%, 7 to <9%, and ≥9% cohorts, respectively (both P < 0.001), and a higher prevalence of neuropathy and nephropathy (both P < 0.001).

CONCLUSIONS:

For adults with type 1 diabetes, glycemic control appears worse than previously estimated. Rates of all complications increased with increasing HbA1c. Compared with HbA1c <7%, HbA1c ≥9% was associated with twofold and 12-fold higher incidences of SH and DKA, respectively. Younger adults had more pronounced higher risks of SH and DKA associated with poor glycemic control than older adults.

PMID:
31548241
DOI:
10.2337/dc19-0830

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