Recent improvements in attainment of the hemoglobin A1c target of ≤7.0% among adults with type 1 diabetes in Ontario: a retrospective cohort study

Aims — We evaluated attainment of the HbA1c target of ≤7.0%, itstemporal trends, and associated factors among adults with type 1 diabetes in Ontario, Canada using administrative data.

Methods — We conducted a retrospective cohort study including Ontarians with type 1 diabetes ≥18 years old with ≥1 HbA1c test between April 1, 2012 (fiscal year 2013) and March 31, 2023. Generalized estimating equations were used to determine probabilities of meeting the HbA1c target, as well as associations between fiscal year and individual-, physician-, and system-level factors on odds of meeting the target.

Results — Among 28,827 adults with type 1 diabetes [14,385 (49.9%) female, 17,998 (62.4%) pump users] with median age at index of 25 years [interquartile range (IQR) 18-37] and median diabetes duration 12 years [6-18], there were 474,714 HbA1c tests (median 2/individual/year (IQR 1-3)). The model-estimated probability of meeting the HbA1c target of ≤7.0% was 22.1% (95% CI 21.6-22.5%) in 2013, remained stable until 2020, and increased to 34.7% (95% CI 34.3 to 35.2%) in 2023. The age-and sex-adjusted odds ratio for meeting the target in 2023 vs. 2013 was 1.87 (95% CI 1.79-1.96). Young adults (18-25 years), diabetic ketoacidosis, greater comorbidity and receiving diabetes care from a non-specialist physician were associated with reduced odds of meeting the HbA1c target.

Conclusions — One-third of adults with type 1 diabetes in Ontario met the recommended HbA1c target of ≤7.0% in 2023, with improvement noted since 2021 which may be due to advanced technologies or effects of the COVID-19 pandemic.