Australia Study Reveals Blood Sugar Control Gaps in Toddlers With Type 1 Diabetes

A study from Australia, led by researchers at the Sydney Children's Hospital Network in Westmead, New South Wales, offers a rare and eye-opening look at how the youngest children living with Type 1 diabetes (T1D) are faring across three continents — and the findings should prompt serious conversation between US families and their care teams.

What the Study Did

Published in Diabetes Care (2024), this international registry analysis compared data from 8,004 children under age 6 diagnosed with Type 1 diabetes. Researchers drew from three major databases covering 2019–2021: the European Diabetes Prospective Follow-Up Registry (DPV), the US-based T1D Exchange Quality Improvement Network (T1DX-QI), and the Australasian Diabetes Data Network (ADDN). This kind of multi-registry comparison is rare and uniquely valuable — it lets us see what's working across different healthcare systems and identify gaps that might otherwise go unnoticed.

Key Findings: Blood Sugar Control

The study measured average blood sugar control using HbA1c, a 3-month blood sugar average. Here's how each region compared:

• Europe (DPV): Average HbA1c of 7.3% — closest to the under-7.0% target
• Australia (ADDN): Average HbA1c of 7.7%
• United States (T1DX-QI): Average HbA1c of 8.0% — the highest of the three

To put this in everyday terms, an HbA1c of 8.0% corresponds to an estimated average blood glucose of roughly 183 mg/dL, compared to about 154 mg/dL for the European average of 7.3%. The American Diabetes Association (ADA) recommends an HbA1c below 7.0% (approximately 154 mg/dL estimated average glucose) for young children when it can be safely achieved without frequent severe low blood sugar episodes.

Overall, only 37.5% of all children hit that under-7.0% target. Among US children specifically, just 25.5% reached the goal — compared to 43.6% in Europe and 27.5% in Australia.

Technology Use: A Surprising Gap

The study also revealed striking differences in diabetes technology use. Insulin pump therapy was used by 86.6% of European children, but only 46.6% of US children and 39.2% of Australian children. Continuous glucose monitor (CGM) use was more widespread — 57.6% in the US and 85.1% in Europe. Hybrid closed-loop (HCL) systems, which automatically adjust insulin delivery, were rarely used across all three regions (under 7% everywhere).

Why This Matters for US Patients

If your child under age 6 has Type 1 diabetes, this study matters for several important reasons:

• The US is falling behind: American toddlers had the highest average HbA1c and the lowest rate of hitting blood sugar targets, despite having access to advanced technologies.
• Technology access isn't everything: Even though CGM use in the US was reasonable, outcomes were still weaker — suggesting access, cost, support systems, and care models all play a role.
• Pump therapy may be underused: European programs that use insulin pumps in nearly 9 out of 10 young children appear to achieve better control. Talk to your child's endocrinologist about whether a pump is right for your family.
• Overweight rates are high: More than 41% of US children in the study had BMI scores in the overweight range, which can complicate diabetes management.

This international perspective — made possible in part by Australian researchers — helps US families and providers see beyond their own system and ask: what can we do better?

Original Study

Sandy, Tittel, Rompicherla, et al. "Demographic, Clinical, Management, and Outcome Characteristics of 8,004 Young Children With Type 1 Diabetes." Diabetes Care, 2024. PMID: 38305782. DOI: 10.2337/dc23-1317