Improvement of Care & Outcome


Regina Prigge, John A McKnight, Sarah H Wild et al. (including Henk Veeze, Henk-Jan Aanstoot and Dick Mul of Diabeter)

International comparison of glycaemic control in people with type 1 diabetes: an update and extension. Diabet Med. 2022 May;39(5):e14766.

It has been known for quite some time now that lower HbA1c reduces the risk of micro- and macro-vascular complications among people with T1D (PWDs). In the last decennium a target HbA1c of 48–58 mmol/mol (6.5–7.5%) has been recommended. Currently the ISPAD recommends HbA1c targets of <53 mmol/mol (<7.0%) for children/adolescents and most non-pregnant adults and a target of <48 mmol/mol (<6.5%) for other adults, unless PWDs have a history of severe hypoglycaemia, severe co-morbidities or limited life expectancy. These targets have been changed partly in the light of evidence of cardiovascular risk reduction due to lower targets and also because of advances in glucose monitoring and automated insulin delivery systems (AIDs). An earlier study assessed how well targets were being achieved between 2010 and 2012 among 324,501 PWDs from 19 countries. This study, co-authored by Henk-Jan Aanstoot, Henk Veeze and Dick Mul of Diabeter, aimed to provide an update of the earlier study in an extended international comparison.


Data between 2016 and 2020 were received from collaborators in 22 countries, of N=520,392 PWDs from 17 national or regional population-based registers (ranging from n=479 to n=283,414 PWDs).

Key findings:

  • A pooled estimate was not assumed to be appropriate as median HbA1c varied from 55 to 79 mmol/mol (7.2 to 9.4%) across data sources and age groups
  • Women were less likely to attain HbA1c targets (OR [95% CI] for HbA1c< 58 mmol/mol [<7.5%]: 0.91 [0.90–0.92]
  • Compared to PWDs aged ≥25 years, those aged <15 years were more likely to achieve HbA1c targets (1.68 [1.65–1.71]) whereas those aged15–24 were less likely to achieve HbA1c targets (0.81 [0.79–0.82])
  • Results remained similar after adjusting for sex, age and data source.
  • Compared to the earlier analysis, the proportion of people with an HbA1c < 58 mmol/l (<7.5%) increased and proportions of people with HbA1c≥ 75 mmol/mol (≥9.0%) decreased.


Concluding, the authors state

"It is possible that wider use of newer technologies including sensors and closed loop systems could contribute to further improvements in glycaemic control, particularly among populations where they are not yet available. However, use of technology is only one factor in glycaemic control and maximising the effectiveness of conventional approaches to management of type 1 diabetes, including education, encouraging acceptance of the condition and frequent glucose measurement, remain important" -

Please click here for the Pubmed link.

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