Background: Management of type 1 diabetes (T1D) involves achieving glycemic targets to avoid complications. However, despite advancements in diabetes technology and standards, achieving adequate glycemic control in children and adolescents remains a challenge. This study aims to identify factors associated with optimal glycemic targets of <7% in the T1DX-QI collaborative, a U.S. based multi-center study.

Methods: The analysis included 9,991 T1D patients (1-18 years) from eight sites in the T1D Exchange Quality Improvement (T1DX-QI) database for whom electronic health record data was available with at least one completed clinic encounter between July 2017-July 2020.

Results: Among those with hemoglobin A1c <7%, more were Non-Hispanic White (72% vs. 66%) and privately insured patients (59% vs. 44%) compared to patients with A1c > 7% [p<0.001]. Additional analysis showed that patients who used both continuous glucose monitor and insulin pump for diabetes management were more likely to have better glycemic control compared to those who did not use this combination.

Conclusions: This study highlights real-world challenges and social disparities in achieving optimal glycemic control. A combination of CGM and insulin pump device use is beneficial for the effective management of blood glucose levels. T1Dx-QI sites are implementing best practices to improve optimal outcomes.

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