Ebekozien, O, Mungmode, A, Sanchez, J, Rompicherla, S, Demeterco-Berggren, C, Weinstock, R, Jacobsen, L, Davis, G, McKee, A, Akturk, H.K, Maahs, D, Kamboj, M.

Objective: Previous studies revealed that hemoglobin A1c (HbA1c) increased overall in the United States in thepast decade. In addition, health inequities in type 1 diabetes (T1D) outcomes by race/ethnicity and insurancetype persist. This study examines the trends in HbA1c from 2016 to 2022 stratified by race/ethnicity andinsurance in a large multicenter national database.

Research Design and Methods: We analyzed glycemic outcomes and diabetes device use trends for>48,000people living with type 1 diabetes (PwT1D) from 3 adult and 12 pediatric centers in the T1D Exchange QualityImprovement Collaborative (T1DX-QI), comparing data from 2016 to 2017 with data from 2021 to 2022.

Results: The mean HbA1c in 2021–2022 was lower at 8.4% compared with the mean HbA1c in 2016–2017 of8.7% (0.3% improvement;P<0.01). Over the same period, the percentage of PwT1D using a continuousglucose monitor (CGM), insulin pump, or hybrid closed-loop system increased (45%, 12%, and 33%,respectively). However, these improvements were not equitably demonstrated across racial/ethnic groups orinsurance types. Racial/ethnic and insurance-based inequities persisted over all 7 years across all outcomes;comparing non-Hispanic White and non-Hispanic Black PwT1D, disparate gaps in HbA1c (1.2%–1.6%), CGM(30%), pump (25%–35%), and hybrid-closed loop system (up to 20%) are illuminated.

Conclusion: Population-level data on outcomes, including HbA1c, can provide trends and insights into strat-egies to improve health for PwT1D. The T1DX-QI cohort showed a significant improvement in HbA1c from2016 to 2022. Improvements in diabetes device use are also demonstrated. However, these increases wereinconsistent across all racial/ethnic groups or insurance types, an important focus for future T1D populationhealth improvement work.

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