Diabetes In Youth Study Research Articles

Health Care Access, Utilization, and Glycemic Control in Youth and Young Adults with Diabetes in South Carolina

Affordability and spatial accessibility are key dimensions of access to health care and important determinants of health. In populations with diabetes, evidence is largely limited to those with type 2 diabetes and older adults. We evaluated the association of insurance coverage and diabetes care provider characteristics with glycemic control in youth and young adults (YYA) with diabetes aged 6 to 30 years (median 16 years), participating in the SEARCH for Diabetes in Youth study in South Carolina between January 2012 and July 2015. A total of 540 YYAs with diabetes (437 type 1, 103 type 2) provided information on health insurance type, diabetes care provider (type and address); HbA1c was measured in-person. Geographic information systems were used to calculate distance to the reported provider. Multivariate linear regression analyses were utilized to evaluate the association. More than half of YYAs with diabetes utilized state/federal insurance (46%) or were uninsured (18%). Only 79% indicated a diabetes care provider. The majority (62%) were seeing an endocrinologist, traveling 27 miles on average (median 16 miles). Average HbA1c was 9.2%. Compared to those with private insurance, YYAs with state/federal health insurance had 0.78 higher HbA1c levels (p<.001) and those with no insurance had 1.1 higher HbA1c (p<.0001), independent of age, sex, race/ethnicity, urbanicity, diabetes type, duration, and medication regimen. Compared to receiving care by an endocrinologist, reporting care by a primary care provider was associated with a 0.6 higher HbA1c (p=.028) and a 0.8 higher level (p=.007) with no routine diabetes care provider reported. Distance to provider was not associated with glycemic control (p=.18). In summary, health insurance status and type, and provider type were significantly associated with glycemic control. This study underscores the importance of social determinants of health on diabetes management outcomes in youth and young adults. Disclosure A.D. Liese: None. X. Ma: None. L. Reid: None. J.M. Eberth: None. B.A. Bell: None. J. Probst: None. C.B. Turley: Stock/Shareholder; Self; AbbVie Inc., Johnson & Johnson Services, Inc., Pfizer Inc., CVS/Caremark, Amgen Inc., Walgreen Co., UnitedHealth Group, Novartis AG, Abbott. E.J. Mayer-Davis: None.

Association between Arterial Stiffness and Cardiovascular Autonomic Neuropathy in Youth with Type 2 Diabetes—SEARCH for Diabetes in Youth Study

Accelerated vascular aging in youth with type 2 diabetes (T2D) makes them vulnerable for a cardiovascular event in early adulthood. We explored the relationship between increased arterial stiffness (AS) and reduced heart rate variability (HRV) in youth with T2D. 193 youth with T2D (age 22 ± 4 years, duration 8 ± 2 years, HbA1c 8.9 ± 4.4%, 40% non-Hispanic black) enrolled in the SEARCH study had PWV (pulse wave velocity carotid-femoral segment) and HRV [standard deviation (SDNN) and root mean square successive difference(RMSSD) of normal RR interval] assessed. AS+ was defined as the PWV > 90th percentile for age and gender-matched healthy controls. Youth with increased AS were older, had higher blood pressure (BP), BMI, triglycerides and lower HDL-c (P ≤ 0.05) (Table). In linear regression analysis, increased PWV was associated with lower SDNN independent of age, gender, race/ethnicity, BP and BMI (β= -0.03, SE=0.02, P=0.04). However, the association was attenuated and non-significant when controlled for triglyceride suggesting that the relationship between AS and HRV is mediated partly by dyslipidemia. TABLE 1. Characteristics of the youth with type 2 diabetes stratified by their arterial stiffness (AS) statusVariableAS –AS +P-valueAge, years22 ± 423 ± 40.008Systolic Blood Pressure, mm Hg115 ± 10121 ± 11<0.001BMI z-score1.9 ± 0.42.4 ± 0.37<0.001HDL-cholesterol, mg/dL43 ± 939 ± 90.002Triglycerides, mg/dL104 (73,175)139 (87,248)0.02HbA1c, %8.7 ± 4.49.5 ± 4.10.28SDNN, msec52(36,79)42(29,62)0.003 Early subclinical atherosclerosis was associated with cardiovascular autonomic neuropathy in young people with T2D which could potentially increase the risk of early cardiovascular events. Interventions targeting the risk factors for AS and CAN are needed. Disclosure M. Jaiswal: None. J. Divers: None. D. Dabelea: None. J.M. Lawrence: None. G. Kim: None. A.D. Liese: None. E.M. Urbina: None.

Changes in diabetes medication regimens and glycemic control in adolescents and young adults with youth-onset type 2 diabetes: The SEARCH for diabetes in youth study.

The aim of this study was to describe recent medication patterns and changes in medication patterns and glycemic control in adolescents and young adults with incident type 2 diabetes (T2D). Using data from the SEARCH for Diabetes in Youth Study, we conducted a cross-sectional analysis of treatments for adolescents and young adults with incident T2D in 2 periods (2002-2005 vs 2008/2012), and a longitudinal analysis of medications and glycemic control for a subset with baseline and follow-up visits. Comparisons were performed using χ2 , Fisher's exact, or ANOVA. Of 646 individuals in the cross-sectional analysis, a majority in each period received metformin (64.9% vs 70.4%) and/or insulin (38.1% vs 38.4%), while fewer used sulfonylureas (5.6% vs 3.6%) with non-significant changes over time. There was a significant reduction in thiazolidinedione use (5.0% vs 2.0%, P < .05). In the longitudinal analysis, 322 participants were followed for 7 years, on average. Baseline metformin users had a lower A1C (6.4% [46.7 mmol/mol]) compared to insulin (8.4% [68.2 mmol/mol], P < .001) or insulin plus any oral diabetes medication (ODM) users (7.7% [60.4 mmol/mol], P < .001). Among baseline metformin users (n = 138), 29.7% reported metformin at follow-up, with the remainder adding (19.6%) or switching to insulin (8.0%), ODM (15.9%), or lifestyle only (26.8%). Of those receiving insulin (±ODM) (n = 129), 76% reported insulin use at follow-up. Overall, 35% were at A1C goal (<7.0%, 53 mmol/mol) at follow-up. Youth-onset T2D is still largely being treated with metformin and/or insulin. The majority treated were not at American Diabetes Association (ADA)-recommended goal 7 years after diagnosis.

Longitudinal association between eating frequency and hemoglobin A1c and serum lipids in diabetes in the SEARCH for Diabetes in Youth study.

Few studies have evaluated the prospective association of eating frequency with HbA1c levels and cardiovascular disease risk markers among youth with diabetes. To examine the 5-year longitudinal association of eating frequency with HbA1c and serum lipid levels among youth with type 1 diabetes (T1D) or type 2 diabetes (T2D). One-thousand and forty-nine youth (≥10-year old) with incident T1D (n = 821) or T2D (n = 228) who participated in the SEARCH for Diabetes in Youth study were included. Eating frequency (≤3, 4-5, or 6-10 times/d) measured at baseline and follow-up visits was related to HbA1c and serum lipid levels measured repeatedly over 5 years. Increased eating frequency was associated with larger increases in HbA1c among youth T1D. For example, for youth with T1D who ate ≤3 times/d at the outset and ate 6-10 times/d 5 years later, the longitudinal model predicted greater absolute increases in HbA1c (2.77%); whereas for youth with T1D who ate 6-10 times/d at the outset and ate ≤3 times/d 5 years later, the model predicted lesser absolute increases in HbA1c (1.33%). Eating frequency was not associated with changes in serum lipid levels among youth with T1D or T2D. Youth with T1D who increased their eating frequency vs those who decreased it had larger increases in HbA1c over 5 years.

Type 2 Diabetes in Youth: New Lessons from the SEARCH Study.

The purpose of this review is to provide an update on the recent body of evidence emerging for type 2 diabetes as identified through the SEARCH for Diabetes in Youth study. This body of evidence illustrates that type 2 diabetes continues to increase in incidence, although this increase may be partially attributable to increased surveillance. Disease management is influenced by the transition from adolescent to adult care and psychosocial factors may also contribute. This evidence also describes a high prevalence of disease-associated complications and comorbidities. Risk factors for cardiovascular disease are also highly prevalent. The SEARCH for Diabetes in Youth study continues to inform our understanding of the descriptive epidemiology and natural history of type 2 diabetes in youth. As the cohort matures, new opportunities emerge for building on our understanding of how youth-onset type 2 diabetes impacts future health.

Mortality in youth-onset type 1 and type 2 diabetes: The SEARCH for Diabetes in Youth study

AimsTo estimate short-term mortality rates for individuals with type 1 or type 2 diabetes diagnosed before age 20 years from the SEARCH for Diabetes in Youth study. MethodsWe included 8358 individuals newly-diagnosed with type 1 (n = 6840) or type 2 (n = 1518) diabetes from 1/1/2002–12/31/2008. We searched the National Death Index through 12/31/2010. We calculated standardized mortality ratios (SMRs) based on age, sex, and race for the comparable US population in the geographic areas of the SEARCH study. ResultsDuring 44,893 person-years (PY) of observation (median follow-up = 5.3 years), 41 individuals died (91.3 deaths/100,000 PY); 26 with type 1 (70.6 deaths/100,000 PY) and 15 with type 2 (185.6 deaths/100,000 PY) diabetes. The expected mortality rate was 70.9 deaths/100,000 PY. The overall SMR (95% CI) was 1.3 (1.0, 1.8) and was high among individuals with type 2 diabetes 2.4 (1.3, 3.9), females 2.2 (1.3, 3.3), 15–19 year olds 2.7 (1.7,4.0), and non-Hispanic blacks 2.1 (1.2, 3.4). ConclusionsCompared to the state populations of similar age, sex, and race, our results show excess mortality in individuals with type 2 diabetes, females, older youth, and non-Hispanic blacks. We did not observe excess short-term mortality in individuals with type 1 diabetes.

Transfer from paediatric to adult care for young adults with Type 2 diabetes: the SEARCH for Diabetes in Youth Study.

To describe factors associated with transfer from paediatric to adult care and poor glycaemic control among young adults with Type 2 diabetes, using the SEARCH for Diabetes in Youth study. Young adults with Type 2 diabetes were included if they had a baseline SEARCH visit while in paediatric care at <18years and ≥1 follow-up SEARCH visit thereafter at 18-25 years. At each visit, HbA1c , BMI, self-reported demographic and healthcare provider data were collected. Associations of demographic factors with transfer of care and poor glycaemic control (HbA1c ≥75mmol/mol; 9.0%) were explored with multivariable logistic regression. 182 young adults with Type 2 diabetes (36% male, 75% minority, 87% with obesity) were included. Most (n=102, 56%) reported transfer to adult care at follow-up; a substantial proportion (n=28, 15%) reported no care and 29% did not transfer. Duration of diabetes [odds ratio (OR) 1.4, 95% confidence interval (95% CI) 1.1, 1.8] and age at diagnosis (OR 1.8, 95% CI 1.4, 2.4) predicted leaving paediatric care. Transfer to adult or no care was associated with a higher likelihood of poor glycaemic control at follow-up (adult: OR 4.5, 95% CI 1.8, 11.2; none: OR 4.6, 95% CI 1.4, 14.6), independent of sex, age, race/ethnicity or baseline HbA1c level. Young adults with Type 2 diabetes exhibit worsening glycaemic control and loss to follow-up during the transfer from paediatric to adult care. Our study highlights the need for development of tailored clinical programmes and healthcare system policies to support the growing population of young adults with youth-onset Type 2 diabetes.

Comment on Jaiswal et al. Prevalence of and Risk Factors for Diabetic Peripheral Neuropathy in Youth With Type 1 and Type 2 Diabetes: SEARCH for Diabetes in Youth Study. Diabetes Care 2017;40:1226–1232

We were interested by the recent article by Jaiswal et al. (1), who reported a high prevalence (22%) of diabetic peripheral neuropathy (DPN) in young subjects with type 2 diabetes in the SEARCH for Diabetes in Youth (SEARCH) study. Although significance was not reached for all the analyses in the type 2 diabetes group, long-term poor glycemic control, dyslipidemia, and smoking emerged as modifiable risk factors, and the authors suggested that their management may help to prevent or delay irreversible nerve damage. This optimistic view is, however, challenged by the results of multifactorial interventions: no improvement of vibration perception thresholds (VPT) in the Steno-2 study (2) and only a small initial improvement with later seemingly inexorable progression …

"Keeping it on your radar"-assessing the barriers and facilitators to a timely diagnosis of type 1 diabetes in childhood: A qualitative study from the early detection of type 1 diabetes in youth study.

SummaryAimsThe aim of this study was to explore from the perspectives of key stakeholders involved in the pathway to diagnosis, the barriers and facilitators to a timely diagnosis of type 1 diabetes in childhood.MethodsQualitative interviews and free‐text analyses were undertaken in 21 parents with a child diagnosed with type 1 diabetes, 60 parents without a child diagnosed with type 1 diabetes, 9 primary healthcare professionals, 9 teachers and 3 community diabetes liaison nurses. Data were analysed thematically and 30% double coded.ResultsTwo key themes were identified, namely the importance of widespread awareness and knowledge and seeking healthcare professional help. Parents with a child diagnosed with type 1 diabetes described seeking opinions from a number of individuals prior to seeking health professional help. Healthcare professionals recognized the rarity of the condition and the need for it to be kept on their “radar”, to ensure they considered it when examining an unwell child. The process of obtaining a primary healthcare appointment was identified as potentially playing a crucial role in the diagnostic process. However, most parents with a child diagnosed with type 1 diabetes described receiving an appointment on the day they sought it.ConclusionsKnowledge and awareness of type 1 diabetes in childhood remain limited in the general population and misconceptions persist relating to how children present with this serious condition. An effective community‐based intervention to raise awareness amongst key stakeholders is required to ensure children receive a timely diagnosis once symptomatic.

Dietary quality and markers of inflammation: No association in youth with type 1 diabetes

BackgroundSystemic inflammation is a key process underlying cardiovascular disease (CVD) development, and CVD risk is significantly elevated in persons with type 1 diabetes (T1D). Youth with T1D exhibit increased levels of inflammation. Studies in persons without diabetes suggest that dietary quality influences inflammation, yet little is known about dietary influences on inflammation in youth with T1D. MethodsThis study evaluated the association of four distinct dietary quality indices (Dietary Approaches to Stop Hypertension (DASH), Healthy Eating Index 2010 (HEI2010), modified KIDMED and Total Antioxidant Capacity (TAC)) with biomarkers of inflammation (C-reactive protein (CRP), fibrinogen and interleukin-6 (IL-6)) in a sample of 2520 youth with T1D participating in the SEARCH for Diabetes in Youth Study. ResultsAverage diet quality was moderate to poor, with mean scores of 43 (DASH, range 0–80), 55 (HEI2010, range 0–100), 3.7 (mKIDMED, range 3–12) and 7237 (TAC). None of the four diet quality scores was associated with the selected biomarkers of inflammation in any analyses. Evaluation of a non-linear relationship or interactions with BMI or levels of glycemic control did not alter the findings. Replication of analyses using longitudinal data yielded consistent findings with our cross-sectional results. ConclusionsBiomarkers of inflammation in youth with T1D may not be directly influenced by dietary intake, at least at the levels of dietary quality observed here. More work is needed to understand what physiologic mechanisms specific to persons with T1D might inhibit the generally beneficial influence of high dietary quality on systemic inflammation observed in populations without diabetes.

Prevalence of and Risk Factors for Diabetic Peripheral Neuropathy in Youth With Type 1 and Type 2 Diabetes: SEARCH for Diabetes in Youth Study.

OBJECTIVEWe assessed the prevalence of and risk factors for diabetic peripheral neuropathy (DPN) in youth with type 1 diabetes (T1D) and type 2 diabetes (T2D) enrolled in the SEARCH for Diabetes in Youth (SEARCH) study.RESEARCH DESIGN AND METHODSThe Michigan Neuropathy Screening Instrument (MNSI) was used to assess DPN in 1,734 youth with T1D (mean ± SD age 18 ± 4 years, T1D duration 7.2 ± 1.2 years, and HbA1c 9.1 ± 1.9%) and 258 youth with T2D (age 22 ± 3.5 years, T2D duration 7.9 ± 2 years, and HbA1c 9.4 ± 2.3%) who were enrolled in the SEARCH study and had ≥5 years of diabetes duration. DPN was defined as an MNSI exam score of >2. Glycemic control over time was estimated as area under the curve for HbA1c.RESULTSThe prevalence of DPN was 7% in youth with T1D and 22% in youth with T2D. Risk factors for DPN in youth with T1D were older age, longer diabetes duration, smoking, increased diastolic blood pressure, obesity, increased LDL cholesterol and triglycerides, and lower HDL cholesterol (HDL-c). In youth with T2D, risk factors were older age, male sex, longer diabetes duration, smoking, and lower HDL-c. Glycemic control over time was worse among those with DPN compared with those without for youth with T1D (odds ratio 1.53 [95% CI 1.24; 1.88]) but not for youth with T2D (1.05 [0.7; 1.56]).CONCLUSIONSThe high rates of DPN among youth with diabetes are a cause of concern and suggest a need for early screening and better risk factor management. Interventions in youth that address poor glycemic control and dyslipidemia may prevent or delay debilitating neuropathic complications.

Serum cystatin C in youth with diabetes: The SEARCH for diabetes in youth study.

We compared cystatin C in youth with versus without diabetes and determined factors associated with cystatin C in youth with type 1 diabetes (T1D) and type 2 diabetes (T2D). Youth (ages 12-19years) without diabetes (N=544) were ascertained from the NHANES Study 2000-2002 and those with T1D (N=977) and T2D (N=168) from the SEARCH for Diabetes in Youth Study. Adjusted means of cystatin C concentrations were compared amongst the 3 groups. Next, we performed multivariable analyses within the T1D and T2D SEARCH samples to determine the association between cystatin C and race, sex, age, diabetes duration, HbA1c, fasting glucose, and BMI. Adjusted cystatin C concentrations were statistically higher in NHANES (0.85mg/L) than in either the T1D (0.75mg/L) or T2D (0.70mg/L) SEARCH groups (P<0.0001). Fasting glucose was inversely related to cystatin C only in T1D (P<0.001) and BMI positively associated only in T2D (P<0.01) while HbA1c was inversely associated in both groups. Cystatin C concentrations are statistically higher in youth without diabetes compared to T1D or T2D, however the clinical relevance of this difference is quite small, especially in T1D. In youth with diabetes, cystatin C varies with BMI and acute and chronic glycemic control, however their effects may be different according to diabetes type.

Sleep and Diabetes in Adolescents: A Battle between Physiology and Social Factors

Page e7 About 200,000 of individuals under 20 years of age have been diagnosed with diabetes. Many of them have type 1 diabetes (T1D) but type 2 diabetes (T2D), a disease that used to be seen primarily in adults over age 45, is becoming more common in young people.1 Results from the ‘SEARCH for Diabetes in Youth study’ released data showing that type 2 diabetes in 10 to 19-year-olds had increased 21% between 2001 and 2009. The study reported an increase among White, Black and Hispanic children.2

Comparing Two Waist-to-Height Ratio Measurements with Cardiometabolic Risk Factors among Youth with Diabetes

Waist circumference (WC) is commonly measured by either the World Health Organization (WHO) or National Health and Nutrition Examination Survey (NHANES) protocol. Compare the associations of WHO vs. NHANES WC-to-height ratio (WHtR) protocols with cardiometabolic risk factors (CMRFs) in a sample of youth with diabetes. For youth (10-19 years old with type 1 [N=3082] or type 2 [N=533] diabetes) in the SEARCH for Diabetes in Youth Study, measurements were obtained of WC (by two protocols), weight, height, fasting lipids (total cholesterol, triglycerides, HDL cholesterol, Non-HDL cholesterol) and blood pressures. Associations of CMRFs with WHO and NHANES WHtR were modeled stratified by body mass index (BMI) percentiles for age/sex: lower BMI (<85th BMI percentile; N=2071) vs. higher BMI (≥85th percentile; N=1594). Among lower-BMI participants, both NHANES and WHO WHtR were associated (p<0.005) with all CMRFs except blood pressure. Among higher-BMI participants, both NHANES and WHO WHtR were associated (p<0.05) with all CMRFs. WHO WHtR was more strongly associated (p<0.05) than NHANES WHtR with triglycerides, non-HDL cholesterol, and systolic blood pressure in lower-BMI participants. Among high-BMI participants, WHO WHtR was more strongly associated (p<0.05) than NHANES WHtR with triglycerides and systolic blood pressure. Among youth with diabetes, WHtR calculated from either WC protocol captures cardiometabolic risk. The WHO WC protocol may be preferable to NHANES WC.

Association of insulin sensitivity (IS) with age at menarche (AAM) in girls with type 1 diabetes (T1D): search for diabetes in youth study

Association of insulin sensitivity (IS) with age at menarche (AAM) in girls with type 1 diabetes (T1D): search for diabetes in youth study

An efficient approach for surveillance of childhood diabetes by type derived from electronic health record data: the SEARCH for Diabetes in Youth Study.

To develop an efficient surveillance approach for childhood diabetes by type across 2 large US health care systems, using phenotyping algorithms derived from electronic health record (EHR) data. Presumptive diabetes cases <20 years of age from 2 large independent health care systems were identified as those having ≥1 of the 5 indicators in the past 3.5 years, including elevated HbA1c, elevated blood glucose, diabetes-related billing codes, patient problem list, and outpatient anti-diabetic medications. EHRs of all the presumptive cases were manually reviewed, and true diabetes status and diabetes type were determined. Algorithms for identifying diabetes cases overall and classifying diabetes type were either prespecified or derived from classification and regression tree analysis. Surveillance approach was developed based on the best algorithms identified. We developed a stepwise surveillance approach using billing code-based prespecified algorithms and targeted manual EHR review, which efficiently and accurately ascertained and classified diabetes cases by type, in both health care systems. The sensitivity and positive predictive values in both systems were approximately ≥90% for ascertaining diabetes cases overall and classifying cases with type 1 or type 2 diabetes. About 80% of the cases with "other" type were also correctly classified. This stepwise surveillance approach resulted in a >70% reduction in the number of cases requiring manual validation compared to traditional surveillance methods. EHR data may be used to establish an efficient approach for large-scale surveillance for childhood diabetes by type, although some manual effort is still needed.

The dose-response effect of insulin sensitivity on albuminuria in children according to diabetes type.

Insulin resistance is associated with microalbuminuria among youth with diabetes mellitus. We sought to determine the dose-response effect of insulin sensitivity (IS) on the magnitude of albuminuria and whether there is a threshold below which urine albumin excretion increases. These analyses included participants from the SEARCH for Diabetes in Youth Study with incident diabetes who completed a baseline study visit (n = 2988). We estimated IS using a validated equation incorporating waist circumference, HbA1C, and fasting serum triglycerides. Multivariate regression analyses were performed to assess the effect of IS on urine albumin creatinine ratio (UACR), stratified by diabetes type. The IS threshold was then determined using segmented regressions within each diabetes type and incorporated into the multivariate model. There was an association between IS and UACR in type 2 diabetes only (beta = -0.39; p < 0.001). There was strong statistical evidence for a threshold effect of IS score on UACR in the group of youth with type 2 (beta = 0.40; p < 0.001) but not type 1 diabetes (p = 0.3). In cross-sectional analyses, there is a negative association between IS and UACR in youth with type 2 but not type 1 diabetes, and this association likely includes a threshold effect of IS on UACR.

Factors influencing time to case registration for youth with type 1 and type 2 diabetes: SEARCH for Diabetes in Youth Study

Factors influencing time to case registration for youth with type 1 and type 2 diabetes: SEARCH for Diabetes in Youth Study

An efficient approach for surveillance of childhood diabetes by type derived from electronic health record data: the SEARCH for Diabetes in Youth Study

An efficient approach for surveillance of childhood diabetes by type derived from electronic health record data: the SEARCH for Diabetes in Youth Study

Progress in Diabetes Technology: Developments in Insulin Pumps, Continuous Glucose Monitors, and Progress towards the Artificial Pancreas

Type 1 diabetes (T1D) is one of the most common chronic diseases of childhood with an estimated prevalence of more than 166 000 cases in children younger than 20 years of age in the US in 2010. 1 Pettitt D.J. Talton J. Dabelea D. Divers J. Imperatore G. Lawrence J.M. et al. Prevalence of diabetes in U.S. youth in 2009: the SEARCH for diabetes in youth study. Diabetes Care. 2014; 37: 402-408 Crossref PubMed Scopus (314) Google Scholar The rate of new-onset diabetes also is increasing worldwide, with an increased incidence of 3%-5% per year. 2 Forlenza G.P. Rewers M. The epidemic of type 1 diabetes: what is it telling us?. Curr Opin Endocrinol Diabetes Obes. 2011; 18: 248-251 Crossref PubMed Scopus (89) Google Scholar In 1993 the Diabetes Control and Complications Trial established the benefit of intensive insulin therapy in reducing long-term complications, including retinopathy, nephropathy, and neuropathy. 3 The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993; 329: 977-986 Crossref PubMed Scopus (22760) Google Scholar Despite this now longstanding knowledge, vascular complications attributable to hyperglycemia remain a significant issue in the population with T1D, even in the young-adult population. 4 James S. Gallagher R. Dunbabin J. Perry L. Prevalence of vascular complications and factors predictive of their development in young adults with type 1 diabetes: systematic literature review. BMC Res Notes. 2014; 7: 593 Crossref PubMed Scopus (33) Google Scholar , 5 Maahs D.M. Daniels S.R. de Ferranti S.D. Dichek H.L. Flynn J. Goldstein B.I. et al. Cardiovascular disease risk factors in youth with diabetes mellitus: a scientific statement from the american heart association. Circulation. 2014; 130: 1532-1558 Crossref PubMed Scopus (123) Google Scholar Recent evidence from the T1D Exchange clinic registry shows that during childhood mean hemoglobin A1c (HbA1c) remains above the target of 7.5% for all age groups, with a peak of 9.2% in the late teenage years. 6 Miller K.M. Foster N.C. Beck R.W. Bergenstal R.M. DuBose S.N. DiMeglio L.A. et al. Current state of type 1 diabetes treatment in the U.S.: updated data from the T1D Exchange Clinic Registry. Diabetes Care. 2015; 38: 971-978 Crossref PubMed Scopus (923) Google Scholar This evidence points toward the urgent need for better therapeutic interventions to improve glycemic control across the pediatric population. Innovations in diabetes care are being pursued on many fronts, including education, behavioral interventions, pharmaceutical development, beta-cell transplantation, and immunomodulation to prevent autoimmune beta-cell destruction. Although these therapies aim to provide benefit now and more so in the future, many in the diabetes community believe that the most impactful near-term benefit will be achieved by innovation in the technologies used to manage diabetes.