Education needs and management of

food intake in children, adolescents

and young adults with Type 1 Diabetes
(T1D): the global TEENs study
Sheridan Waldron1, Lori Laffel2, Catherine Domenger3, Valerie Pilorget4,
Christophe Candelas4, Thomas Danne5, Moshe Phillip6, Carmen Mazza7,
Barbara Anderson8, Ragnar Hanas9, Roy Beck10, Chantal Mathieu11
1Birmingham, UK; 2Boston, MA, USA; 3Paris, France; 4Chilly Mazarin, France;
5Hannover, Germany; 6Petah Tikva, Israel; 7Buenos Aires, Argentina;
8Houston, TX, USA; 9Gothenburg, Sweden; 10Tampa, FL, USA; 11Leuven,
Belgium.

Presenter disclosure: Sheridan Waldron

Research support: N/A

Speakers Bureau: N/A

Board Member/Advisory Panel: T1D advisory board,
Sanofi

Stock/Shareholder: N/A
Consultant: Sanofi; Lilly
Employee: N/A
Other: N/A
Study sponsored by Sanofi

Background
Many youths with T1D are still not meeting HbA1c targets1,2
Diabetes management is a burden, with many barriers to
achieving target glycemic control, especially for adolescents.3
Further understanding of these challenges could improve
diabetes outcomes

TEENs study
is the largest worldwide, contemporary, observational study
and has assessed the main factors associated with HbA1c target
attainment in 5,960 youth with T1D, aged 825 years old (y/o)

Aim:
This analysis of TEENs describes associations between
diabetes education needs, management of food intake and
attainment of HbA1c target
1. Wood JR, et al. Diabetes Care 2013; 36 (7): 20357; 2. Laffel LM, et al. Diabetes 2014; 63 (Suppl. 1); Abstract 32-OR;
3. Borus JS, et al. Curr Opin Pediatr 2010; 22 (4): 40511.

TEENs study worldwide recruitment

20 countries & 219 sites

USA
25 sites
499 participants

LATIN AMERICA
(Argentina/Mexico)
27 sites
470 participants

EUROPE
(Denmark/France/Germany/Hungary/Italy/
Portugal/Romania/Russia/Slovenia/
Spain/Sweden)
111 sites
2943 participants

SOUTH AFRICA
5 sites
507 participants

MIDDLE EAST/NORTH
AFRICA
Algeria/Jordan/
Lebanon/Morocco
33 sites
1041 participants

INDIA
18 sites
500 participants

Methods

Data collected from participants/families and centers by:

Survey, interview and medical record review

Participants recruited sequentially from centers caring for

>100 T1D patients/year

Target recruitment ratio of 1:2:1 for 3 age groups: 812,

1318 and 1925 year olds

HbA1c measured uniformly with A1cNow (ref 46%)

Outcomes described according to age group and

HbA1c target

Factors associated with HbA1c target attainment identified

by multivariate logistic regression adjusted for age group
and region
A1cNow is a trademark of Bayer AG

Participant characteristics and glycemic control

Half (51%) of study participants were male, most were Caucasian (73%)

Mean (SD) duration of T1D was 4.5 (2.7) years in 812 y/o,
6.6 (3.8) years in 1318 y/o, and 11 (4.9) years in 1925 y/o
72% of study participants did not attain HbA1c target*
HbA1c target met

Participants, %

100

80
60
40
20

32

29

812
(n=1723)

1318
(n=2854)

19
1925
(n=1382)

Age group, y/o

HbA1c target

12
10
8
6
4

8,3

8,6

8,4

812

1318

1925

2
0
(n=1723)

(n=2854)
(n=1381)
Age group, y/o

Participants 18 years old: <7.5% (ISPAD)

Participants >18 years old: <7% (ADA)
Note: ADA 2014 guidelines now also recommend HbA1c target <7.5% for <18 y/o
*HbA1c targets:

SD, standard deviation

Overall Mean HbA1c 8.5%

Mean HbA1c, % (SD)

HbA1c target not met

Results: Participant-reported education needs

and glycemic control
Participants expressing a
need for education, %
Most frequently reported
education needs

Managing T1D during illness

Managing blood glucose with exercise
Nutrition and dietary issues
Carbohydrate counting
Insulin administration
Insulin dose adjustment

HbA1c
target* met

HbA1c target
not met

34
40
34
24
25
27

37
39
37
26
28
30

All ages commonly expressed a need for

further diabetes education
*HbA1c targets:

Participants 18 years old: <7.5% (ISPAD)

Participants >18 years old: <7% (ADA)

Results: Participant-reported education needs

Diabetes management
50

812 y/o

1318 y/o

1925 y/o

45

Proportion of
participants (%)

40
35
30

41

41
35

35

40
36

25

20
15
10
5
0
Managing T1D during illness

Managing blood glucose with

exercise

Results: Participant-reported education needs

Nutrition
50

812 y/o

1318 y/o

1925 y/o

45

Proportion of
participants (%)

40
35
30

36

37
33
30

25

27
23

20
15
10

5
0
Nutrition and dietary issues

Carbohydrate counting

Results: Participant-reported education needs

Insulin management
50

812 y/o

1318 y/o

1925 y/o

45
Proportion of
participants (%)

40
35
30
25
20

34
31
29

27
23

26

15
10
5
0
Insulin administration

Insulin dose adjustment

Results: Associations with target attainment

OR [95% CI]

Interested vs not interested to

learn more about:
Learn more about
High-risk
behaviors
high-risk behaviors
(alcohol,
drugs,
sex,
(alcohol,
drugs,
smoking)
sex, smoking)

1.24 [1.06, 1.45]; p=0.008

How to use a CGM

1.25 [1.06, 1.48]; p=0.008

0,5

Less likely to attain HbA1c target

1,5

2,5

More likely to attain HbA1c target

OR for attaining HbA1c target

Participants interested in learning more about high-risk

behaviors and continuous glucose monitoring were more likely
to attain HbA1c target vs those not interested in these topics
*HbA1c targets:

Participants 18 years old: <7.5% (ISPAD)

Participants >18 years old: <7% (ADA)

Results: Management of food intake and glycemic control

Carbohydrate counting

Based on experience

Weighing/measuring

Avoiding sugars

100

Proportion of participants (%)

90

80

6
6
7

11
5
8

70
60

34
35

50

Carbohydrate exchanges

Food intake: majority used

carbohydrate counting or based
on experience
A significant association was
observed between carb counting
& glycemic control (p=0.005)

40

30
20

45

38

10
0
HbA1c
target
HbA
1c target met
met

target
HbAHbA1c
1c target not met
not met

*HbA1c targets:

Those who 'only avoided sugars'

were 40% less likely to attain
target than those who
'carbohydrate counted'
(OR [95% CI]: 0.61 [0.45, 0.84])

Participants 18 years old: <7.5% (ISPAD)

Participants >18 years old: <7% (ADA)

Conclusions
Desire for more education was seen across all age groups
Associated with HbA1c target attainment: if interested (vs
not) in learning more about
high-risk behaviors
continuous glucose monitoring

Using carbohydrate counting (vs other methods) was

associated with target attainment
To improve % of young people reaching HbA1c target:
find out individual education needs
actively engage them in their care

Acknowledgements

A warm thanks to:

Members of the TEENs Steering Committee

TEENs National Coordinators

All TEENs principal investigators and co-investigators

All the patients and families that participated in the study

Sanofi Type 1 Diabetes Team