Abstract P435: Trends and Disparities in Glycemic Control Among Youth and Adults With Type 1 Diabetes in the US Health System: 2008-2022

Introduction: Glycemic control is crucial for type 1 diabetes (T1D) management, yet contemporary data in the US are scarce. This study aims to investigate trends in glycemic control among US youth and adults with T1D from 2008 through 2022. Hypothesis: Glycemic control has improved over time. Methods: We used a well-validated algorithm to identify patients with T1D using de-identified electronic health record data from the Optum Labs Data Warehouse. We characterized trends in hemoglobin A1c (HbA1c) <7% from 2008-2010 to 2020-2022, overall and by age, sex, and race/ethnicity. Results: We included 128,821 patients with T1D (17% youth under age 18 years, mean age 38 years, 48% female, 78% non-Hispanic White). Among youth, mean HbA1c decreased from 8.9% in 2008-2010 to 8.5% in 2020-2022 ( P<.001 ), and the percentage with HbA1c <7% increased from 8% to 16% ( P<.001 ). The percentage with HbA1c <7% did not differ by age or sex, and it was notably higher in Non-Hispanic White youth than racial/ethnic minority youth in 2020-2022 ( Figure A-D ). Among adults, mean HbA1c decreased from 8.2% in 2008-2010 to 8.1% in 2020-2022 ( P<.001 ). Trend in percentage with HbA1c <7% among adults increased significantly from 20% in 2008-2010 to 26% in 2020-2022 ( P<.001 ). Adults who were older and White were more likely to have HbA1c <7% compared to younger and Black or Hispanic adults in all years ( Figure E-F ). Conclusion: There have been marginal improvements in glycemic control among patients with T1D over the last 15 years. Overall, percentage with HbA1c<7% remains low, particularly among youth and racial/ethnic minority patients. There is an urgent need to expand access to care and diabetes technology to enhance management in the population.