Maahs et al. in Diabetologia compare T1D Exchange to Germany-Austrian DPV – July 15, 2014

On June 4, Diabetologia published a study comparing the clinical care and outcomes of children under age six with type 1 diabetes in the US and Germany/Austria (n=2,622). Data was collected from the T1D Exchange in the US and from the Prospective Diabetes Follow-up Registry (DPV) in Germany/Austria. The analysis found that T1D Exchange participants had a significantly higher mean A1c than DPV participants (8.2% vs. 7.4%) and were significantly less likely to achieve A1c targets of <7.5% (22% vs. 56%) or <8.5% (66% vs. 90%). The percentage of patients using an insulin pump was significantly lower in the T1D Exchange than in the DPV (50% vs. a very striking 74%), and the frequency of DKA in the past year was twice as high in the T1D Exchange (6% vs. 3%). Despite the difference in A1c, rates of severe hypoglycemia in the past year were not significantly different between the groups (2.8% in T1D Exchange vs. 1.9% in DPV) – this served as another reminder that severe hypoglycemia remains a key area of unmet need across the globe, regardless of improvements in A1c or greater use of pump therapy. The authors concluded that increased insulin pump use in the DPV cohort was likely one factor behind the group’s better glycemic control, but not the entire explanation (there was a remaining 0.5% difference in mean A1c when only pump users were considered). One hypothesis proposed in the paper is that the lower A1c target of <7.5% used in Germany/Austria (set by ISPAD) compared to the ADA target of <8.5% at the time “may have contributed to the discrepancy.” There will be ample opportunity for future studies to test that hypothesis, as the ADA changed its pediatric A1c guidelines at this year’s Scientific Sessions – the ADA now recommends a target A1c of <7.5% for pediatric patients.