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Our recently published report highlights improvements in the HbA1c trends of 48,000 people with type 1 diabetes (T1D) from three adult and 12 pediatric centers in the T1D Exchange Quality Improvement Collaborative (T1DX-QI).
The T1DX-QI currently brings together 55 endocrinology clinics across the United States treating over 85,000 people with type 1 diabetes — and 20,000+ with type 2 diabetes through a new pilot program.
To date, the T1DX-QI has published 60 studies across major diabetes journals including Diabetes Care, The Lancet, BMJ Open Diabetes Research & Care, and Diabetes Research & Clinical Practice.
The first report of HbA1c improvements in 10+ years
Commonly referred to as A1c, this routine blood test is a critical part of diabetes patient care. A1c levels indicate the amount of glucose that has been attached to red blood cells during the previous three months — higher blood glucose levels lead to higher A1c levels.
The American Diabetes Association recommends that most patients strive for an A1c at or below 7% to reduce their risk of developing diabetes-related complications.
This report from the T1DX-QI — written by Ann Mungmode, MPH, CPHQ, Saketh Rompicherla, MS, Laura Jacobsen, MD, Alexis McKee, MD, and Halis Kaan Akturk, MD — is encouraging.
The report shows significant improvements in A1c levels between 2016/2017 to 2021/2022:
- The percentage of patients with an A1c below 7% increased from 20% to 26%
- The percentage of patients with an A1c above 9% decreased from 43% to 31%
“These findings are significant because it changes the narrative,” explains Osagie Ebekozien, MD, MPH, CPHQ Executive Vice President, Chief Medical Officer at T1D Exchange.
Ebekozien points to the T1D Exchange research published in 2019 documenting worsening A1c trends from 2010-2018 across the United States despite the many advancements in diabetes technology, insulin, and medications. The groundbreaking research — which has been referenced in over 1,300 other studies — revealed the fact that most with T1D do not meet the goal of an A1c below 7%.
“There has been no other major multi-center US-based paper showing improvement in A1c outcomes until now,” explains Ebekozien. “We are grateful for evidence supporting the impact of quality improvement collaboration. Our work is making a major difference and improving the health of populations.”
Increasing prescriptions for diabetes technology
“Over the same period, the percentage of people with diabetes using a continuous glucose monitor (CGM), insulin pump, or hybrid closed-loop system in these 15 centers also increased dramatically,” adds Ebekozien.
- CGM use increased by 45%
- Insulin pump use increased by 12%
- Hybrid closed-loop system use increased by 33%
Ebekozien reminds us, though, that racial-ethnic and insurance-based inequities are still evident within the findings — with the most increased use of diabetes technology seen in non-Hispanic White patients.
The T1DX-QI has been working intensely to shine a brighter light on health inequities within diabetes care through the Health Equity Advancement Lab (HEAL) — with a significant focus on increasing access to diabetes technology and documenting the impact of COVID-19 based on racial-ethnic and insurance-based factors.
Research from the T1DX-QI has revealed that most people who achieve A1c levels below 7% are:
- Significantly more likely to be using a CGM and/or insulin pump
- More likely to have private insurance
- Less likely to have a depression or anxiety diagnosis
- Less likely to experience acute complications, including DKA or severe hypoglycemia
- More likely to be non-Hispanic white
The T1DX-QI’s success in improving A1c levels is fueled by identifying and addressing critical areas of improvement in patient care. These initiatives include addressing health inequities in prescriptions for technology, identifying provider bias, developing provider bias training, improving screenings for mental health concerns, developing custom support programs for at-risk patients, and more.
While A1c isn’t the only important measurement in evaluating the well-being of a person with type 1 diabetes, it’s a critical component, explains Ebekozien.
“Our success so far is encouraging, and we will continue our work through the collaborative to reach more patients and improve more lives.”
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