Contemporary Study Data Offer Overview of Challenges, Outcomes for Adolescents with T1D, T2D

Catherine Pihoker, MD
Credit: Seattle Children's Hospital

An analysis of data from the SEARCH and TODAY studies is offering clinicians a contemporary overview of care access and health outcomes among people with type 1 diabetes (T1D) as well as type 2 diabetes (T2D).

Conducted by investigators representing major institutions, including the Centers for Disease Control and Prevention, University of Michigan, and the Barbara Davis Diabetes Center, results of the study detail distinct differences in challenges associated with management based on type of diabetes, with those with T2D reporting greater difficulties in access to care, but those with T1D experiencing a more pronounced financial burden as a result of their disease.¹

“Results of this study suggested that lack of health care coverage and of an established source of diabetes care were associated with significantly higher HbA1c levels for participants with T1D, but inconsistent results were found for participants with T2D,” wrote investigators.¹ “Increased access to diabetes care (eg, through Medicaid expansion) may be associated with improved health outcomes, but additional strategies are needed, particularly for individuals with T2D.”

Funded by the Centers for Disease and Prevention (CDC) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the SEARCH for Diabetes in Youth study is a national, multicenter study aimed at developing a more thorough understanding about diabetes among children and young adults with youth-onset diabetes in the US. Launched in 2000, the study contains data related to more than 20,000 participants from centers in South Carolina, Ohio, Colorado, California, and Washington.²

The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) trial, which was also funded by the NIDDK, was a randomized clinical trial conducted from (2004-2011), with a follow-up observational study conducted from 2012-2020. The trial enrolled 699 children aged 10-17 years with type 2 diabetes and randomized them to metformin alone, metformin plus rosiglitazone, or metformin plus lifestyle intervention. Since publication in the New England Journal of Medicine in 2012, the document has been cited by more than 650 published articles.³

Leveraging survey data from these studies, a team led by Catherine Pihoker, MD, chief of the division of pediatrics at the University of Washington, launched the current study with the intent of comparing patterns of health care coverage, access to, and use of diabetes care and determine their associations with glycemic control in these patients. Overall, 1371 parity pants are identified for inclusion in the current study. This cohort had a mean age of 25 (range, 18-36) years, 60.1% were female, and the mean diabetes duration was 11.8 (SD, 2.8) years. Of the 1371 included in the study, 661 had T1D and 710 had T2D. Of note, 250 patients with T2D were obtained from the SEARCH study and the other 460 were obtained from the TODAY study.¹

Upon analysis, results indicated more participants with T1D than T2D in both the SEARCH and TODAY studies reported health care coverage (94.7%, 81.6%, and 86.7%), access to diabetes care (94.7%, 78.1%, and 73.4%), and use of diabetes care (88.1%, 80.5%, and 73.6%). Further analysis of health care coverage revealed not having coverage was associated with significantly greater mean HbA1c levels in participants with T1D (no coverage, 10.8% [0.5%]; public, 9.4% [0.2%]; private, 8.7% [0.1%]; P < .001) and in participants with T2D from the TODAY study (no coverage, 9.9% [0.3%]; public, 8.7% [0.2%]; private, 8.7% [0.2%]; P=.004).¹

In analysis of expenses, results indicated the T1D group incurred higher median monthly out-of-pocket expenses than the T2D group ($74.50 [10.00-309.00] vs $10.00 [0-74.50]).When assessing the impact of Medicaid expansion, results indicated expansion was associated with improved health care coverage and lower HbA1c levels.¹

% with Coverage (Expansion vs Without Expansion)¹

• In T1D: 95.8% vs 90.2%
• In T2D (SEARCH): 86.1% vs 73.9%
• In T2D (TODAY): 93.6% vs 74.2%

Mean HbA1c Levels (Expansion vs Without Expansion)¹

• In T1D: 9.2% vs 9.7%
• In T2D (SEARCH): 8.4% vs 9.3%
• In T2D (TODAY): 8.7% vs 9.3%

“Ensuring that processes and structures of care optimize access to diabetes care and health care coverage for younger adults with diabetes could play a role in lower HbA1c levels and improved health outcomes in this high-risk population,” investigators wrote.¹ “Effective education on optimizing diabetes care in younger adults is essential, given the sizeable portion of those who reported not seeking care because they rarely or never get sick yet had high mean HbA1c levels. There is an urgent need for additional strategies to improve outcomes for younger adults with diabetes, particularly T2D.”

References:

1. Pihoker C, Braffett BH, Songer TJ, et al. Diabetes Care Barriers, Use, and Health Outcomes in Younger Adults With Type 1 and Type 2 Diabetes. JAMA Netw Open. 2023;6(5):e2312147. doi:10.1001/jamanetworkopen.2023.12147
2. Phs-Risu. Search for diabetes in Youth. SEARCH for Diabetes in Youth. Accessed May 9, 2023. https://www.searchfordiabetes.org/dspHome.cfm.
3. TODAY Study Group, Zeitler P, Hirst K, et al. A clinical trial to maintain glycemic control in youth with type 2 diabetes. N Engl J Med. 2012;366(24):2247-2256. doi:10.1056/NEJMoa1109333