Objective: International societies and clinical practice guidelines recommend a Hemoglobin A1c target of ≤7.0% for the majority of adults with type 1 (T1D) and type 2 diabetes (T2D). However, the proportion meeting this target and its predictors have not been comprehensively described outside of the USA or in population-based data sources.

Methods: Adults with diabetes were identified in the National Diabetes Repository, a primary care electronic medical record (EMR) database from 5 Canadian provinces, from January 2015 to June 2019. Individuals were categorized as T1D (using a previously validated algorithm), T2D not prescribed insulin, or T2D prescribed insulin. Using the most recent HbA1c, proportions of individuals with HbA1c ≤7.0% were determined and compared using Chi-square tests. Multivariable logistic regression models were used to assess the association between predictors and meeting the HbA1c target.

Results: Of 83,273 eligible adults in the National Diabetes Repository, 1484 had T1D, 10,473 had T2D prescribed insulin and 71,316 had T2D not prescribed insulin. Proportions meeting the HbA1c target of ≤7.0% were 23.9%, 24.9%, and 62.4%, respectively (p=0.4 for T1D vs. T2D prescribed insulin, p<0.0001 for other comparisons). In multivariable logistic regression models, depression was associated with reduced likelihood of meeting the HbA1c target for T1D (OR 0.74, 95% CI 0.55-0.98). Male sex, lower income quintile, and insulin use were associated with reduced likelihood of meeting the HbA1c target for T2D (0.85(0.83-0.88); 0.83(0.79-0.88); 0.23(0.22-0.24)).

Conclusions: In a Canadian population-based primary-care EMR database, less than one-fourth of adults with T1D and T2D prescribed insulin, whereas two-thirds of adults with T2D not prescribed insulin, attain the recommended HbA1c target of ≤7.0%. Further research and implementation approaches are required to optimize outcomes in diabetes, particularly for those requiring insulin.

Disclosure

A. Weisman: None. B. A. Perkins: Advisory Panel; Self; Abbott Diabetes, Boehringer Ingelheim International GmbH, Insulet Corporation, Novo Nordisk Canada Inc., Other Relationship; Self; Abbott Diabetes, Medtronic, Novo Nordisk Canada Inc.

Funding

Diabetes Action Canada

© 2021 by the American Diabetes Association
2021
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