New research presented today at the American Diabetes Association (ADA) 80th Scientific Sessions revealed a continuing and troubling trend in glycemic management among children and young adults with type 1 and type 2 diabetes.

Faisal Malik MD, MSHS  of the University of Washington presented the new data from the SEARCH for diabetes in youth study effort, which involved five different research centers across the US and is funded by the Centers for Disease Control and Prevention (CDC) and the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK).

Study Design

Researchers included over 6,000 young people with a diabetes diagnosis of at least one year in duration in the study. They evaluated and compared the trends in the overall HbA1c levels over time (years 2002-2019). They also evaluated these trends based on the study subjects’ duration of diabetes (1-4 years, 5-9 years, and 10+ years). The data were adjusted for location, age, sex, race/ethnicity, as well as for health insurance status.

Study Outcomes

The table below summarizes the findings of the changes in average A1c levels among youth in the US.

Malik et al. (Presented at ADA 2020)

The researchers concluded the following after completing their analysis:

“Despite increased availability of diabetes technology, newer therapies, and more aggressive glycemic targets over time, current youth and young adults with T1D in the U.S. have worse glycemic control than earlier cohorts. Similarly, participants with T2D diagnosed in childhood and diabetes duration of 10+ years exhibit the temporal trend of worse glycemic control in recent years.”

In particular, the worsening of glycemic management was especially prominent among those with type 1 diabetes of 5-9 years in duration and among those with type 2 diabetes of over 10 years in duration.

Additional key points include the following:

• A large proportion of youth with diabetes are not meeting treatment targets. As per the ADA press release, “The estimated average A1C for the most recent cohort of youth and young adults with type 1 diabetes was 8.7%, while the most recent group with type 2 diabetes had an estimated average A1c of 8.5%.”
• Those with type 1 diabetes in the following age ranges — 10-14, 15-19, and 20-24 years — continue to show a trend of worsening control as compared to the earlier matched cohort (2002-2007).
• Those with type 2 diabetes who were 35 years and older also showed a worsening in glycemic management outcomes as compared to earlier.

Conclusions

Overall, this data reveals a troubling trend for many youth with diabetes in the US, as many are not meeting their targets and the higher A1c levels over time, despite advances in treatment in technology is troubling, to say the least.

Dr. Malik had this to say on the subject:

““These results suggest that not all youth and young adults with diabetes are directly benefiting from the increased availability of diabetes technology, newer therapies, and the use of more aggressive glycemic targets for youth with diabetes over time. Given the evidence highlighting the benefits of tight glycemic control, this study reinforces the need for interventions that combine the use of diabetes technology with effective behavioral and social approaches to improve A1C levels.”

Dr. Dana Dabelea, MD, PhD, from the University of Colorado, who chaired the symposium, added:

“Given the evidence of early complications despite current therapeutic approaches, continuing the long-term follow up of youth with diabetes is necessary to expand our understanding of its natural history, so the most appropriate approaches to primary, secondary, and tertiary prevention of diabetes and its complications can be developed and implemented.”

In summary, this data strongly indicates that better preventative, educational, and comprehensive treatment approaches and follow-up is critical to improving diabetes care for youth in the US.

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