Objective: Previous studies revealed that hemoglobin A1c (HbA1c) increased overall in the United States in the past decade. In addition, health inequities in type 1 diabetes (T1D) outcomes by race/ethnicity and insurance type persist. This study examines the trends in HbA1c from 2016 to 2022 stratified by race/ethnicity and insurance in a large multicenter national database. Research Design and Methods: We analyzed glycemic outcomes and diabetes device use trends for >48,000 people living with type 1 diabetes (PwT1D) from 3 adult and 12 pediatric centers in the T1D Exchange Quality Improvement Collaborative (T1DX-QI), comparing data from 2016 to 2017 with data from 2021 to 2022. Results: The mean HbA1c in 2021-2022 was lower at 8.4% compared with the mean HbA1c in 2016-2017 of 8.7% (0.3% improvement; P < 0.01). Over the same period, the percentage of PwT1D using a continuous glucose monitor (CGM), insulin pump, or hybrid closed-loop system increased (45%, 12%, and 33%, respectively). However, these improvements were not equitably demonstrated across racial/ethnic groups or insurance types. Racial/ethnic and insurance-based inequities persisted over all 7 years across all outcomes; comparing non-Hispanic White and non-Hispanic Black PwT1D, disparate gaps in HbA1c (1.2%-1.6%), CGM (30%), pump (25%-35%), and hybrid-closed loop system (up to 20%) are illuminated. Conclusion: Population-level data on outcomes, including HbA1c, can provide trends and insights into strategies to improve health for PwT1D. The T1DX-QI cohort showed a significant improvement in HbA1c from 2016 to 2022. Improvements in diabetes device use are also demonstrated. However, these increases were inconsistent across all racial/ethnic groups or insurance types, an important focus for future T1D population health improvement work.

中文翻译：

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来自 T1D Exchange 质量改进合作组织的 48,000 多名 1 型糖尿病患者的血糖结果和技术使用的纵向趋势（2016-2022 年）。

目的：之前的研究表明，过去十年美国的糖化血红蛋白 (HbA1c) 总体有所增加。此外，1 型糖尿病 (T1D) 结局因种族/民族和保险类型而存在的健康不平等现象依然存在。本研究调查了大型多中心国家数据库中按种族/族裔和保险分层的 2016 年至 2022 年 HbA1c 趋势。研究设计和方法：我们分析了 T1D 交换质量改进合作组织 (T1DX-QI) 的 3 个成人中心和 12 个儿科中心的超过 48,000 名 1 型糖尿病 (PwT1D) 患者的血糖结果和糖尿病设备使用趋势，并比较了 2016 年的数据使用 2021 年至 2022 年的数据计算至 2017 年。结果：2021 年至 2022 年的平均 HbA1c 较低，为 8.4%，而 2016 年至 2017 年的平均 HbA1c 为 8.7%（改善了 0.3%；P < 0.01）。同一时期，使用连续血糖监测仪 (CGM)、胰岛素泵或混合闭环系统的 PwT1D 比例有所增加（分别为 45%、12% 和 33%）。然而，这些改进并没有在不同种族/族裔群体或保险类型中得到公平的体现。种族/民族和基于保险的不平等在过去 7 年的所有结果中都持续存在；比较非西班牙裔白人和非西班牙裔黑人 PwT1D，HbA1c (1.2%-1.6%)、CGM (30%)、泵 (25%-35%) 和混合闭环系统（高达 20%）的不同差距) 被照亮。结论：包括 HbA1c 在内的人群层面的结果数据可以为改善 PwT1D 健康的策略提供趋势和见解。T1DX-QI 队列显示，从 2016 年到 2022 年，HbA1c 显着改善。还证明了糖尿病设备使用的改善。然而，这些增长在所有种族/族裔群体或保险类型中并不一致，这是未来 T1D 人口健康改善工作的一个重要重点。