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Diabet Med. 2019 Sep 26. doi: 10.1111/dme.14148. [Epub ahead of print]

The Transatlantic HbA1c gap: differences in glycaemic control across the life-span between the US T1D Exchange and German/Austrian DPV registries.

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University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany.
German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
Jaeb Center for Health Research, Tampa, FL, USA.
Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria.
Children's Mercy Hospital, Kansas City, MO, USA.
Division of Endocrinology and Diabetes, RWTH Aachen University, Aachen, Germany.
Department of Pediatrics, Medical University of Graz, Graz, Austria.
Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Duesseldorf University, Duesseldorf, Germany.
Baylor College of Medicine, Houston, TX, USA.
Stanford University, Palo Alto, CA, USA.
Stanford Diabetes Research Center, Stanford, CA, USA.



To compare HbA1c levels across the lifespan in young people in the USA with those in young people in Germany/Austria, and to examine potential differences in HbA1c levels between sexes, insulin delivery methods and minority status.


Data were extracted from the US Type 1 Diabetes Exchange Registry (n=18 381 participants from 73 sites) and from the German/Austrian Prospective Diabetes Follow-up Registry, the DPV (n=32 643 participants from 362 sites). Mean HbA1c was calculated for each year of age for individuals aged ≤25 years, and at 2-year age intervals for individuals aged >25 years. Curves for mean HbA1c by age were estimated using locally weighted scatterplot smoothing. HbA1c differences between registries, sexes, insulin delivery methods, and minority status were assessed by age group using multiple linear regression.


In both registries, mean HbA1c increased by ~11 mmol/mol (1.0%) between the ages of 9 and 18 years, although at quite different absolute levels: from 66 mmol/mol (8.2%) to 77 mmol/mol (9.2%) in the Type 1 Diabetes Exchange Registry, and from 56 mmol/mol (7.3%) to 66 mmol/mol (8.2%) in the DPV. Sex differences were observed in the DPV only. In the Type 1 Diabetes Exchange Registry, injection users had higher mean HbA1c than pump users across the lifespan, whereas in the DPV higher HbA1c levels in injection users were observed in the age groups 6 to <12 years, 12 to <18 years, and 30 to <50 years (P<0.001). Minority status was significantly associated with higher HbA1c in most age groups in both registries.


Significant differences in HbA1c were noted between the USA and Germany/Austria, with disparities more pronounced in early childhood through to young adulthood. Further studies should identify causes for these disparities.


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