Changes in HbA1c between 2011-2017 in Germany/Austria, Sweden, and the United States: A Lifespan Perspective.

Aims This study assessed HbA1c across the lifespan in people with type 1 diabetes (T1D) in Germany/Austria, Sweden, and the United States (U.S.) between 2011 and 2017 to ascertain temporal and age-related trends. Methods Data from the DPV (n=25,651 in 2011, n=29,442 in 2017); SWEDIABKIDS/NDR, (n=44,474 in 2011, n=53,690 in 2017); and T1D Exchange (n=16,198 in 2011, n=17,087 in 2017) registries were analyzed by linear regression to compare mean HbA1c overall and by age group. Results Controlling for age, sex and T1D duration, HbA1c increased in the U.S. between 2011 and 2017, decreased in Sweden, and did not change in Germany/Austria. Controlling for sex and T1D duration, mean HbA1c decreased between 2011 and 2017 in all age cohorts in Sweden (P 25 years (P Conclusions The comparison of international trends in HbA1c makes it possible to identify differences, explore underlying causes, and share quality improvement processes. National quality improvement initiatives have yet to be implemented systematically in the U.S., but are well accepted in Europe. The lack of universal access to healthcare combined with high out-of-pocket cost in the U.S. create barriers to health equity and may limit the efficacy of quality improvement initiatives.