Differences between patients with type 1 diabetes with optimal and suboptimal glycaemic control: A real‐world study of more than 30000 patients in a US electronic health record database

• Published in: Diabetes, obesity & metabolism Vol. 22; no. 4; pp. 622 - 630
• Main Authors: Pettus, Jeremy H, Zhou, Fang Liz, Shepherd, Leah, Mercaldi, Katie, Preblick, Ronald, Hunt, Phillip R, Paranjape, Sachin, Miller, Kellee M, Edelman, Steven V
• Format: Journal Article
• Language: English
• Published: Oxford Wiley Subscription Services, Inc 01.04.2020
• Subjects: Cardiovascular disease; Coronary artery disease; Demographics; Demography; Diabetes; Diabetes mellitus (insulin dependent); Diabetic ketoacidosis; Electronic medical records; Emergency medical care; Heart diseases; Hemoglobin; Hypertension; Hypoglycemia; Ketoacidosis; Microvasculature; Obesity; Observational studies; Patients; Resource utilization; Risk factors; United States > US
• ISSN: 1462-8902; 1463-1326
• DOI: 10.1111/dom.13937

AimsTo use electronic health record data from real‐world clinical practice to assess demographics, clinical characteristics and disease burden of adults with type 1 diabetes (T1D) in the United States.Materials and methodsRetrospective observational study of adults with T1D for ≥24 months at their first visit with a T1D diagnosis code (“index date”) between July 2014 and June 2016 in the Optum Humedica database. Demographic characteristics, acute complications (severe hypoglycaemia [SH], diabetic ketoacidosis [DKA]), microvascular complications, cardiovascular (CV) events and health care resource utilization during the 12 months before the index date (“baseline period”) were compared between patients with optimal versus suboptimal glycaemic control (glycated haemoglobin [HbA1c] <7.0% vs. ≥7.0% [53 mmol/mol]) at the closest measurement to the index date.ResultsOf 31 430 adults with T1D, 79.9% had suboptimal glycaemic control (mean HbA1c 8.8% [73 mmol/mol]). These patients were more likely to be younger, African American, uninsured or on Medicaid, obese, smokers, have uncontrolled hypertension and have depression. Despite worse glycaemic control and increased CV risk factors of uncontrolled hypertension, obesity and smoking, rates of coronary heart disease and stroke were not higher in these patients. Patients with suboptimal glycaemic control also experienced more diabetes complications (including SH, DKA and microvascular disease) and utilized more emergency care, with more emergency department visits and inpatient stays.ConclusionThis real‐world study of >30 000 adults with T1D showed that individuals with suboptimal versus optimal glycaemic control differed significantly in terms of health care coverage, comorbidities, diabetes‐related complications, health care utilization and CV risk factors. However, suboptimal control was not associated with increased risk of CV outcomes.