OR14-3 The Association of Glycemic Control and Glycemic Variability with Treatment Patterns and Diabetes-Related Events in the Adult Patients (Pts) with Type 1 Diabetes (T1D): Results from the T1D Exchange Clinic Registry

Abstract

This cross-sectional analysis evaluated the association of A1C control/variability with treatment patterns and outcomes in adult pts with T1D.The association of A1C control (categorized into <7.0%; 7.0-8.0%; 8.0-9.0%; and ≥9.0%) and variability (defined as intrapersonal mean [M] and adjusted standard deviation [SD] of A1C values, categorized into low M/low SD = low; low M/high SD = medium; high M/low SD = high; and high M/high SD = very high) with pt characteristics, treatment patterns, and diabetes-related events (e.g. diabetic ketoacidosis [DKA], hypoglycemia, and comorbidities) were evaluated using T1D Exchange Clinic Registry data (05-01-2016 to 07-31-2017). Pts were required to have A1C values and key outcomes at exam, and ≥4 A1C values measured within 1 year from exam date for A1C variability analysis. Pts with a history of pancreas or islet cell transplant or currently pregnant were excluded. The association between A1C control/variability and diabetes-related outcomes were evaluated using multiple logistic regression adjusting for covariates.8331 and 2466 pts were included for A1C control and A1C variability analysis, respectively. The majority of the adult T1D pts did not achieve A1C<7.0% (78% pts had A1C≥7.0%) and had increased A1C variability (65% pts in medium to very high groups).Compared with the A1C<7.0% group, pts in the A1C≥9.0% group were significantly younger (29 vs 43 years) and with significantly shorter T1D duration (16 vs 25 years); both p<0.001. Ethnic minorities, lower socioeconomic status, being single, and smoking were also associated with poor A1C control; all p<0.001. Pts on pump or other adjunctive treatment (non-insulin injection, statin use, continuous glucose monitoring [CGM] use) were more likely to have better A1C control (all p<0.001). Poor A1C control (≥9.0%) was significantly associated with greater risk for DKA (adjusted odds ratio [aOR] of 5.7 for the A1C≥9.0% group vs <7.0%), retinopathy (aOR 2.5), neuropathy (aOR 1.8), micro nephropathy (aOR 1.9), and renal disease (aOR 1.9); all p<0.01.Similar associations were observed between A1C variability and pt demographics and disease duration. Pts on pump, statin use, or CGM use were more likely to have low A1C variability; all p<0.001. The very high A1C variability group (high M/high SD) was significantly associated with greater risk for DKA (aOR of 13.5 vs the low A1C variability group), severe hypoglycemia (aOR 4.8), neuropathy (aOR 2.2), micro nephropathy (aOR 2.3), and renal disease (aOR 2.8); all p<0.05.Lack of glycemic control and stability are associated with younger age, shorter disease duration, ethnic minorities, and low socioeconomic status. This study confirms the previously established association between glycemic control and diabetes-related complications and highlights the association of glycemic variability across both acute and long-term diabetes-related complications.