The study compares acute complications among adults with type 1 diabetes (T1D) by glycemic control in a U.S. Electronic Health Record database (T1PCO) with the German/Austrian Prospective Diabetes Follow-up (DPV). T1PCO included 31,430 and DPV 5,190 individuals in the analysis (age ≥18 years, T1D duration ≥2 years). During baseline (12 months prior to index date), ≥1 HbA1c and ≥1 insulin prescription was required. Baseline demographics, severe hypoglycemia (SH) and diabetic ketoacidosis (DKA) were analyzed for overall populations, by age group, and glycemic control (HbA1c categories). In both databases, incidence of DKA was highest in those with HbA1c ≥9.0%. Additionally, the incidence of DKA (per year) increased with deteriorating control (HbA1c<8%: 1.3% vs. 1.7%, HbA1c≥10%: 19.9% vs. 22.9%; DPV and T1PCO respectively). In contrast, incidence of SH patterns differed between the databases. While in the T1PCO cohort SH increased with poorer glycemic control, the trend was reversed in DPV cohort (Figure). Real-world comparisons demonstrate the challenges in diabetes care across many countries around the world. Different patterns of incidence of SH by HbA1c may be related to differences in the capture of SH in databases, it may also reflect important differences in diabetes management including access to different types of insulin, CGM, pumps, education and type 1 savvy health care providers.
F.L. Zhou: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. J. Hermann: None. J. Pettus: Consultant; Self; Diasome Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., MannKind Corporation, Novo Nordisk Inc., Sanofi. W. Kerner: None. K. Miller: None. L. Stechemesser: None. S. Edelman: Advisory Panel; Self; Brightsight, InPen, Lexicon Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk A/S. Board Member; Self; Senseonics. Speaker’s Bureau; Self; AstraZeneca, MannKind Corporation, Merck & Co., Inc., Sanofi. A.M. Ibald-Mulli: Employee; Self; Sanofi-Aventis. R.W. Holl: None.