1679-P: Current State of Type 1 Diabetes in Adults: Data from the Canadian LMC Diabetes Registry

Abstract

Population-based data regarding the current state of T1D care remains limited. This cross-sectional study describes adults with T1D in the LMC Diabetes Registry, comprised of the longitudinal health data of >50 Endocrinology practices across 3 Canadian provinces. A cohort of 3386 adults under care ≥6 months were included: age 44.4 ± 15.3 years; age at diagnosis 22.6 ± 14.3 years; 54.8% male (Table). The majority use analogue insulin (98.4% basal and 99.8% bolus insulin use), 36.6% use an insulin pump and 12.8% use a CGM device. Mean A1C at referral was 8.6 ± 1.8%; current mean A1C was lower at 8.1 ± 1.5%. Although 23.5% were at target A1C ≤ 7.0%, a persistent A1C > 9.0% was seen in 21.6%. Mean A1C was highest among young adults. Over half (56%) reported >1 weekly episodes of hypoglycemia; 3.3% reported severe hypoglycemia in the prior year. In CGM users (n=352, mean A1C 7.7 ± 1.3%), mean glucose was 9.4 ± 2.0 mmol/L and mean CV was 38.5 ± 8.3%. Time in range was 54.4 ± 17.8% and time in hypoglycemia was 6.3 ± 6.1%. Common comorbidities included mental health (9.8%), microvascular (retinopathy 14.4%, CKD 8.2%, nephropathy 24.5%, clinically significant neuropathy 6.5%) and macrovascular (5.5%) disorders. Despite care from diabetes specialists, operating with advanced resources, and within a public health system, the majority of Canadian adults with T1D are not reaching glycemic targets and under-use available advanced technologies. Disclosure R. Aronson: Research Support; Self; AstraZeneca, Becton, Dickinson and Company, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Medtronic, Merck & Co., Inc., Novo Nordisk Inc., Sanofi, Senseonics. R.E. Brown: None. A. Abitbol: Advisory Panel; Self; Merck & Co., Inc., Novo Nordisk Inc. Research Support; Self; Amgen Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Eli Lilly and Company, Gilead Sciences, Inc., GlaxoSmithKline plc., JDRF, Lexicon Pharmaceuticals, Inc., Pfizer Inc., Senseonics, Xeris Pharmaceuticals, Inc., Zealand Pharma A/S. Speaker's Bureau; Self; AstraZeneca, Sanofi. R. Goldenberg: Advisory Panel; Self; Amgen Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc., Sanofi. O. Ajala: None. J. Yale: Advisory Panel; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc., Sanofi. Research Support; Self; AstraZeneca, Bayer Canada, Mylan. Speaker's Bureau; Self; Abbott, AstraZeneca, Bayer Canada, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc., Sanofi, Takeda Canada. Z. Yared: None. Funding Sanofi Canada