Care Gaps Found in Older Adults With Type 1 Diabetes Across US and European Registries
Study of 3600 older adults with type 1 diabetes across US and European registries reveals significant gaps in guideline-recommended cardiovascular therapies and diabetes technology use despite high disease burden.
Less than half of older adults with type 1 diabetes receive guideline-recommended therapies, including lipid-lowering treatment for secondary prevention and diabetes technologies, despite high hypoglycemia risk and a high prevalence of atherosclerotic cardiovascular disease, according to study findings published in the Journal of the Endocrine Society.
The cross-sectional comparative analysis included 3600 adults aged at least 60 years with median ages of 67.5 years in the T1D Exchange Quality Improvement Collaborative (T1DX-QI; n=1549) and 68.9 years in the Diabetes Prospective Follow-up registry (DPV; n=2051) across the United States, Austria, and Germany.
The DPV registry showed a higher prevalence of both atherosclerotic cardiovascular disease (34.6% vs 16.8%) and chronic kidney disease (28.5% vs 11.8%) compared with the T1DX-QI. Use of cardiovascular protective therapies was also more common in the DPV, including lipid-lowering therapy for secondary prevention (52.9% vs 38%) and angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker therapy (55.3% vs 44.8%).
In contrast, adoption of diabetes technologies favored the T1DX-QI, with similar rates of continuous glucose monitoring (50.3% vs 47.9%) but substantially higher insulin pump use (40.7% vs 17%) and automated insulin delivery use (20.4% vs 6.4%).
In both registries, the prevalence of atherosclerotic cardiovascular disease and chronic kidney disease increased significantly with advancing age (P <.001) and was consistently greater in the DPV than the T1DX-QI. Hyperlipidemia and hypertension affected more than half of the participants in both cohorts and did not differ significantly across age groups.
Current tobacco use was approximately twice as common in the DPV compared with T1DX-QI (15.4% vs 7.4%). In the DPV, smoking prevalence declined markedly with increasing age (21.4% to 2.1%; P <.001), whereas in the T1DX-QI, tobacco use peaked among individuals aged older than 80 years (10%).
Despite well-established benefits of reducing cardiovascular events and slowing kidney disease progression, management of cardiovascular risk factors in type 1 diabetes remains inconsistent. Although use of advanced diabetes technologies has increased, their uptake and care outcomes among adults aged older than 60 years remain poorly characterized due to limited age-specific data.
Study limitations include an observational design, missing or incomplete data, potential underreporting of complications, limited information on diabetes duration and socioeconomic factors, and less generalizability from specialty clinic-based registries.