Association of Sex and Other Demographic Characteristics With Hemoglobin A1c in Older Adults With Type 1 Diabetes: Cross-Sectional Analysis of the U.S. Premier Healthcare Database.

OBJECTIVE

In type 1 diabetes, results for hemoglobin A1c (HbA1c) sex-based differences are mixed, with limited data in later ages. The study objective was to determine whether female sex is independently associated with higher HbA1c in the U.S. older adult population.

RESEARCH DESIGN AND

METHODS

A cross-sectional analysis was performed on real-world data from the Premier Healthcare Database from January 2020 to December 2022 examining adults with type 1 diabetes, ages 55-75 years. Multivariable linear and logistic regression models were used to determine demographic variables independently associated with HbA1c. Predictor variables included age, sex, race, ethnicity, insurance payor, testing location, marital status, and atherosclerotic cardiovascular disease.

RESULTS

Of 12,088 individuals with HbA1c data (52.4% women, mean age 64.7 ± 5.8 years), HbA1c was 0.13% (95% CI 0.08, 0.18; P < 0.001) higher on average in women and 0.81-0.97% higher in Black patients, adjusting for all other variables. Female sex (unadjusted odds ratio [OR] 1.13; 95% CI 1.05, 1.21; P < 0.001; adjusted OR [aOR] 1.16; 95% CI 1.07, 1.26; P < 0.001), Black compared with White race (aOR 1.78; 95% CI 1.49, 2.12; P < 0.001), and Medicaid compared with Managed Care payor (aOR 1.63; 95% CI 1.28, 2.07; P < 0.001) were independently associated with increased odds of HbA1c above target, ≥7% for ages 55-64 years and ≥8.5% for ages ≥65 years.

CONCLUSIONS

In this cohort with type 1 diabetes, women experienced slightly higher HbA1c and higher odds of HbA1c above recommendations. Individuals with Black race and Medicaid insurance payor experienced clinically significantly higher HbA1c levels. Further interventions to address HbA1c disparities are needed.