AIMS To use electronic health record data from real-world clinical practice to assess demographics, clinical characteristics and disease burden of adults with type 1 diabetes (T1D) in the United States. MATERIALS AND METHODS Retrospective observational study of adults with T1D for ≥24 months at their first visit with a T1D diagnosis code ("index date") between July 2014 and June 2016 in the Optum Humedica database. Demographic characteristics, acute complications (severe hypoglycaemia [SH], diabetic ketoacidosis [DKA]), microvascular complications, cardiovascular (CV) events and health care resource utilization during the 12 months before the index date ("baseline period") were compared between patients with optimal versus suboptimal glycaemic control (glycated haemoglobin [HbA1c] <7.0% vs. ≥7.0% [53 mmol/mol]) at the closest measurement to the index date. RESULTS Of 31 430 adults with T1D, 79.9% had suboptimal glycaemic control (mean HbA1c 8.8% [73 mmol/mol]). These patients were more likely to be younger, African American, uninsured or on Medicaid, obese, smokers, have uncontrolled hypertension and have depression. Despite worse glycaemic control and increased CV risk factors of uncontrolled hypertension, obesity and smoking, rates of coronary heart disease and stroke were not higher in these patients. Patients with suboptimal glycaemic control also experienced more diabetes complications (including SH, DKA and microvascular disease) and utilized more emergency care, with more emergency department visits and inpatient stays. CONCLUSION This real-world study of >30 000 adults with T1D showed that individuals with suboptimal versus optimal glycaemic control differed significantly in terms of health care coverage, comorbidities, diabetes-related complications, health care utilization and CV risk factors. However, suboptimal control was not associated with increased risk of CV outcomes.

中文翻译：

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血糖控制最佳与欠佳的1型糖尿病患者之间的差异：美国电子病历数据库中3万多名患者的真实研究。

目的在美国，使用来自现实世界临床实践的电子健康记录数据来评估1型糖尿病（T1D）成人的人口统计学，临床特征和疾病负担。材料与方法于2014年7月至2016年6月间在Optum Humedica数据库中对首次患有T1D≥24个月的成年人进行T1D诊断代码（“索引日期”）的回顾性观察研究。比较了患者在指标日期之前的12个月（“基线期”）的人口统计学特征，急性并发症（严重的低血糖症[SH]，糖尿病性酮症酸中毒[DKA]），微血管并发症，心血管（CV）事件和卫生保健资源利用情况最佳血糖控制与最佳血糖控制相比（糖化血红蛋白[HbA1c] <7.0％vs.≥7。0％[53 mmol / mol]）。结果在31 430名患有T1D的成年人中，有79.9％的血糖控制不理想（平均HbA1c为8.8％[73 mmol / mol]）。这些患者更可能是年轻，非裔美国人，未投保或正在接受医疗补助，肥胖，吸烟者，高血压不受控制且患有抑郁症。尽管血糖控制较差且高血压，肥胖和吸烟不受控制的心血管风险因素增加，但这些患者的冠心病和中风发生率并不高。血糖控制不佳的患者还经历了更多的糖尿病并发症（包括SH，DKA和微血管疾病），并利用了更多的急诊护理，急诊就诊和住院时间也更多。结论这项对>的现实研究 3万名患有T1D的成年人表明，血糖控制欠佳与最佳之间的个体在医疗保健覆盖率，合并症，糖尿病相关并发症，医疗保健利用和CV危险因素方面有显着差异。然而，次优控制与CV结果风险增加无关。