Changes in HbA1c Between 2011 and 2017 in Germany/Austria, Sweden, and the United States: A Lifespan Perspective

Anastasia Albanese-O'Neill; Julia M Grimsmann; Anna-Marie Svensson; Kellee M Miller; Klemens Raile; Karin Akesson; Peter Calhoun; Beate Biesenbach; Katarina Eeg-Oloffson; Reinhard W. Holl; David M Maahs; Ragnar Hanas

doi:10.1089/dia.2021.0225

Changes in HbA1c Between 2011 and 2017 in Germany/Austria, Sweden, and the United States: A Lifespan Perspective

Anastasia Albanese-O'Neill
, Julia M Grimsmann
, Anna-Marie Svensson
, Kellee M Miller
, Klemens Raile
, Karin Akesson
, Peter Calhoun
, Beate Biesenbach
, Katarina Eeg-Oloffson
, Reinhard W. Holl
, David M Maahs
, Ragnar Hanas

Department of Pediatrics and Adolescent Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Abstract Aims: This study assessed hemoglobin A1c (HbA1c) across the lifespan in people with type 1 diabetes (T1D) in Germany/Austria, Sweden, and the United States between 2011 and 2017 to ascertain temporal and age-related trends. Methods: Data from the Diabetes-Patienten-Verlaufsdokumentation (DPV) (n = 25,651 in 2011, n = 29,442 in 2017); Swedish Pediatric Diabetes Quality Registry (SWEDIABKIDS)/National Diabetes Register (NDR), (n = 44,474 in 2011, n = 53,690 in 2017); and T1D Exchange (n = 16,198 in 2011, n = 17,087 in 2017) registries were analyzed by linear regression to compare mean HbA1c overall and by age group. Results: Controlling for age, sex, and T1D duration, HbA1c increased in the United States between 2011 and 2017, decreased in Sweden, and did not change in Germany/Austria. Controlling for sex and T1D duration, mean HbA1c decreased between 2011 and 2017 in all age cohorts in Sweden (P < 0.001). In the United States, HbA1c stayed the same for participants <6 years and 45 to <65 years and increased in all other age groups (P < 0.05). In Germany/Austria, HbA1c stayed the same for participants <6 to <13 years and 18 to <25 years; decreased for participants ages 13 to <18 years (P < 0.01); and increased for participants ≥25 years (P < 0.05). Conclusions: The comparison of international trends in HbA1c makes it possible to identify differences, explore underlying causes, and share quality improvement processes. National quality improvement initiatives are well accepted in Europe but have yet to be implemented systematically in the United States. However, disparities created by the lack of universal access to health care coverage, unequal access to diabetes technologies (e.g., continuous glucose monitoring) regardless of insurance status, and high out-of-pocket cost for the underinsured ultimately limit the potential of quality improvement initiatives. Keywords: Benchmarking; Epidemiology; Quality improvement; Type 1 diabetes.

Original language	English
Pages (from-to)	32-41
Number of pages	10
Journal	Diabetes Technology and Therapeutics
Volume	24
Issue number	1
DOIs	https://doi.org/10.1089/dia.2021.0225
Publication status	Published - Jan 2022

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being
SDG 10 Reduced Inequalities

Fields of science

302035 Paediatrics and adolescent medicine

Access to Document

10.1089/dia.2021.0225

Cite this

Albanese-O'Neill, A., Grimsmann, J. M., Svensson, A.-M., Miller, K. M., Raile, K., Akesson, K., Calhoun, P., Biesenbach, B., Eeg-Oloffson, K., Holl, R. W., Maahs, D. M., & Hanas, R. (2022). Changes in HbA1c Between 2011 and 2017 in Germany/Austria, Sweden, and the United States: A Lifespan Perspective. Diabetes Technology and Therapeutics, 24(1), 32-41. https://doi.org/10.1089/dia.2021.0225

@article{345c2a8daaf24fcfad343fb0a4950a52,

title = "Changes in HbA1c Between 2011 and 2017 in Germany/Austria, Sweden, and the United States: A Lifespan Perspective",

abstract = "Abstract Aims: This study assessed hemoglobin A1c (HbA1c) across the lifespan in people with type 1 diabetes (T1D) in Germany/Austria, Sweden, and the United States between 2011 and 2017 to ascertain temporal and age-related trends. Methods: Data from the Diabetes-Patienten-Verlaufsdokumentation (DPV) (n = 25,651 in 2011, n = 29,442 in 2017); Swedish Pediatric Diabetes Quality Registry (SWEDIABKIDS)/National Diabetes Register (NDR), (n = 44,474 in 2011, n = 53,690 in 2017); and T1D Exchange (n = 16,198 in 2011, n = 17,087 in 2017) registries were analyzed by linear regression to compare mean HbA1c overall and by age group. Results: Controlling for age, sex, and T1D duration, HbA1c increased in the United States between 2011 and 2017, decreased in Sweden, and did not change in Germany/Austria. Controlling for sex and T1D duration, mean HbA1c decreased between 2011 and 2017 in all age cohorts in Sweden (P < 0.001). In the United States, HbA1c stayed the same for participants <6 years and 45 to <65 years and increased in all other age groups (P < 0.05). In Germany/Austria, HbA1c stayed the same for participants <6 to <13 years and 18 to <25 years; decreased for participants ages 13 to <18 years (P < 0.01); and increased for participants ≥25 years (P < 0.05). Conclusions: The comparison of international trends in HbA1c makes it possible to identify differences, explore underlying causes, and share quality improvement processes. National quality improvement initiatives are well accepted in Europe but have yet to be implemented systematically in the United States. However, disparities created by the lack of universal access to health care coverage, unequal access to diabetes technologies (e.g., continuous glucose monitoring) regardless of insurance status, and high out-of-pocket cost for the underinsured ultimately limit the potential of quality improvement initiatives. Keywords: Benchmarking; Epidemiology; Quality improvement; Type 1 diabetes.",

author = "Anastasia Albanese-O'Neill and Grimsmann, \{Julia M\} and Anna-Marie Svensson and Miller, \{Kellee M\} and Klemens Raile and Karin Akesson and Peter Calhoun and Beate Biesenbach and Katarina Eeg-Oloffson and Holl, \{Reinhard W.\} and Maahs, \{David M\} and Ragnar Hanas",

year = "2022",

month = jan,

doi = "10.1089/dia.2021.0225",

language = "English",

volume = "24",

pages = "32--41",

journal = "Diabetes Technology and Therapeutics",

issn = "1557-8593",

number = "1",

}

Albanese-O'Neill, A, Grimsmann, JM, Svensson, A-M, Miller, KM, Raile, K, Akesson, K, Calhoun, P, Biesenbach, B, Eeg-Oloffson, K, Holl, RW, Maahs, DM & Hanas, R 2022, 'Changes in HbA1c Between 2011 and 2017 in Germany/Austria, Sweden, and the United States: A Lifespan Perspective', Diabetes Technology and Therapeutics, vol. 24, no. 1, pp. 32-41. https://doi.org/10.1089/dia.2021.0225

TY - JOUR

T1 - Changes in HbA1c Between 2011 and 2017 in Germany/Austria, Sweden, and the United States: A Lifespan Perspective

AU - Albanese-O'Neill, Anastasia

AU - Grimsmann, Julia M

AU - Svensson, Anna-Marie

AU - Miller, Kellee M

AU - Raile, Klemens

AU - Akesson, Karin

AU - Calhoun, Peter

AU - Biesenbach, Beate

AU - Eeg-Oloffson, Katarina

AU - Holl, Reinhard W.

AU - Maahs, David M

AU - Hanas, Ragnar

PY - 2022/1

Y1 - 2022/1

N2 - Abstract Aims: This study assessed hemoglobin A1c (HbA1c) across the lifespan in people with type 1 diabetes (T1D) in Germany/Austria, Sweden, and the United States between 2011 and 2017 to ascertain temporal and age-related trends. Methods: Data from the Diabetes-Patienten-Verlaufsdokumentation (DPV) (n = 25,651 in 2011, n = 29,442 in 2017); Swedish Pediatric Diabetes Quality Registry (SWEDIABKIDS)/National Diabetes Register (NDR), (n = 44,474 in 2011, n = 53,690 in 2017); and T1D Exchange (n = 16,198 in 2011, n = 17,087 in 2017) registries were analyzed by linear regression to compare mean HbA1c overall and by age group. Results: Controlling for age, sex, and T1D duration, HbA1c increased in the United States between 2011 and 2017, decreased in Sweden, and did not change in Germany/Austria. Controlling for sex and T1D duration, mean HbA1c decreased between 2011 and 2017 in all age cohorts in Sweden (P < 0.001). In the United States, HbA1c stayed the same for participants <6 years and 45 to <65 years and increased in all other age groups (P < 0.05). In Germany/Austria, HbA1c stayed the same for participants <6 to <13 years and 18 to <25 years; decreased for participants ages 13 to <18 years (P < 0.01); and increased for participants ≥25 years (P < 0.05). Conclusions: The comparison of international trends in HbA1c makes it possible to identify differences, explore underlying causes, and share quality improvement processes. National quality improvement initiatives are well accepted in Europe but have yet to be implemented systematically in the United States. However, disparities created by the lack of universal access to health care coverage, unequal access to diabetes technologies (e.g., continuous glucose monitoring) regardless of insurance status, and high out-of-pocket cost for the underinsured ultimately limit the potential of quality improvement initiatives. Keywords: Benchmarking; Epidemiology; Quality improvement; Type 1 diabetes.

AB - Abstract Aims: This study assessed hemoglobin A1c (HbA1c) across the lifespan in people with type 1 diabetes (T1D) in Germany/Austria, Sweden, and the United States between 2011 and 2017 to ascertain temporal and age-related trends. Methods: Data from the Diabetes-Patienten-Verlaufsdokumentation (DPV) (n = 25,651 in 2011, n = 29,442 in 2017); Swedish Pediatric Diabetes Quality Registry (SWEDIABKIDS)/National Diabetes Register (NDR), (n = 44,474 in 2011, n = 53,690 in 2017); and T1D Exchange (n = 16,198 in 2011, n = 17,087 in 2017) registries were analyzed by linear regression to compare mean HbA1c overall and by age group. Results: Controlling for age, sex, and T1D duration, HbA1c increased in the United States between 2011 and 2017, decreased in Sweden, and did not change in Germany/Austria. Controlling for sex and T1D duration, mean HbA1c decreased between 2011 and 2017 in all age cohorts in Sweden (P < 0.001). In the United States, HbA1c stayed the same for participants <6 years and 45 to <65 years and increased in all other age groups (P < 0.05). In Germany/Austria, HbA1c stayed the same for participants <6 to <13 years and 18 to <25 years; decreased for participants ages 13 to <18 years (P < 0.01); and increased for participants ≥25 years (P < 0.05). Conclusions: The comparison of international trends in HbA1c makes it possible to identify differences, explore underlying causes, and share quality improvement processes. National quality improvement initiatives are well accepted in Europe but have yet to be implemented systematically in the United States. However, disparities created by the lack of universal access to health care coverage, unequal access to diabetes technologies (e.g., continuous glucose monitoring) regardless of insurance status, and high out-of-pocket cost for the underinsured ultimately limit the potential of quality improvement initiatives. Keywords: Benchmarking; Epidemiology; Quality improvement; Type 1 diabetes.

UR - https://pubmed.ncbi.nlm.nih.gov/34524026/

U2 - 10.1089/dia.2021.0225

DO - 10.1089/dia.2021.0225

M3 - Article

SN - 1557-8593

VL - 24

SP - 32

EP - 41

JO - Diabetes Technology and Therapeutics

JF - Diabetes Technology and Therapeutics

IS - 1

ER -

Changes in HbA1c Between 2011 and 2017 in Germany/Austria, Sweden, and the United States: A Lifespan Perspective

Abstract

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