Looking Beyond HbA1c in T1D: Other Clinical Metrics for Patient Outcomes

Looking Beyond HbA1c in T1D: Other Clinical Metrics for Patient Outcomes

Developed in collaboration

Released: 10/27/2021
Expires: 10/25/2023
Max Credits: 0.5
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Anne Peters, MD
Director, USC Clinical Diabetes Program
Professor of Clinical Medicine, Keck School of Medicine of USC
University of Southern California
Los Angeles, CA

Jay H. Shubrook, DO, FACOFP, FAAFP
Professor, Primary Care Department
Director of Clinical Research and Diabetes Services
Touro University California
College of Osteopathic Medicine
Vallejo, CA

Activity Planners
Aaron J. Kowalski, PhD
President and CEO
New York, NY

Nicole Johnson, DrPH, MPH, MA
Vice President of Operations in Science and Health Care
American Diabetes Association
Arlington, VA

Aly Bancroft, MPH
Campaign Coordinator
Public Citizen
Washington, DC

Jaime Symowicz, PhD
Manager, Educational Strategy and Content
Baltimore, MD

Samantha Gordon, MS
Accreditation Manager
Baltimore, MD

Amy Sison
Director of CME
Baltimore, MD

Kathryn Schaefer, MSN, RN, CPHRM, CHCP
Associate Director, Education Quality and Compliance
East Lansing, MI
Learning Objectives
Upon completion, participants should be able to:

  • Describe the benefits and limitations of using HbA1c to measure outcomes for patients with T1D
  • Summarize the clinical implications of glucose variability, time in range, and glucose management indicator

Target Audience
This activity is intended for primary care clinicians (primary care physicians, pediatricians, nurse practitioners, physician assistants, and nurses), pharmacists, endocrinologists, and certified diabetes care and education specialists.
Statement of Need
In the United States, approximately 1.4 million adults and 187,000 children are currently living with type 1 diabetes (T1D). Importantly, only 21% of adults and 17% of children with T1D are reaching their HbA1c goals. In addition, T1D is a challenging and demanding condition, and many individuals are burdened by insulin treatment plans, hypoglycemia concerns, and psychosocial issues. However, technological advances (eg, continuous glucose monitoring, insulin pumps) and new therapies continue to emerge that can help address patients’ challenges and encourage them to take a more active role in their care. An estimated 64,000 new cases of T1D are expected to be diagnosed each year, which includes 27,000 new cases in children and 37,000 new cases in adults. The American Diabetes Association Standards of Care recommend that people with diabetes receive care from a coordinated interdisciplinary team consisting of certified diabetes care and education specialists (CDCES), pharmacists, and primary care and specialty providers, including physicians, nurse practitioners, physician assistants, and nurses. Therefore, it is imperative that all members of the diabetes care team stay up-to-date on all aspects of T1D care to improve patient outcomes, such as using other measures to assess clinical outcomes; understanding the role of continuous glucose monitoring, insulin pumps, and adjunctive therapies; and providing support for psychosocial issues to best meet the needs of this growing patient population.

Collaboration Statement
Developed in collaboration


Accreditation/Designation Statements
Med-IQ is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Med-IQ designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Med-IQ is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

This nursing activity has been approved for up to 0.5 contact hour.

ACPEMed-IQ is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. 0.5 contact hour (0.05 CEU) of credit for pharmacists. ACPE #0476-0000-21-011-H01-P. This knowledge-based activity is designed for all pharmacists.

Certified Diabetes Educators who successfully complete the activity will receive a Statement of Participation indicating the maximum AMA PRA Category 1 Credit(s)™ awarded for the activity. The National Certification Board of Diabetes Educators (NCBDE) does not approve continuing education, continuing education activities must be diabetes related and approved by a provider on the NCBDE list of Approved Providers (

Physician assistants and other healthcare professionals who successfully complete the activity will receive a Statement of Participation indicating the maximum credits available.

Instructions to Receive Credit
To receive credit, read the introductory CE material, watch the webcast, and complete the evaluation, attestation, and post-test, answering at least 70% of the post-test questions correctly.
Initial Release Date: October 27, 2021
Expiration Date: October 25, 2023
Estimated Time to Complete This Activity: 30 minutes

Disclosure Policy
Med-IQ requires any person in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines “relevant financial relationships” as those in any amount occurring within the past 24 months that could create a conflict of interest (COI). Individuals who refuse to disclose will not be permitted to contribute to this CME activity in any way. Med-IQ has policies in place that will identify and resolve COIs prior to this educational activity. Med-IQ also requires faculty to disclose discussions of investigational products or unlabeled/unapproved uses of drugs or devices regulated by the US Food and Drug Administration.
Drug/Product Usage by Faculty
Off-label/unapproved drug uses or products are mentioned within this activity.

Disclosure Statement
The content of this activity has been peer reviewed and has been approved for compliance. The faculty and contributors have indicated the following financial relationships, which have been resolved through an established COI resolution process, and have stated that these reported relationships will not have any impact on their ability to give an unbiased presentation.
Anne Peters, MD
Consulting fees/advisory boards: Abbott Laboratories, AstraZeneca, Lilly, Novo Nordisk
Contracted research: Abbott Laboratories, Dexcom, Inc., Insulet Corporation
Ownership interest (stocks/stock options – excluding mutual funds): Omada Health, Inc., Teladoc Health, Inc.

Jay H. Shubrook, DO, FACOFP, FAAFP
Consulting fees/advisory boards: AstraZeneca, Bayer HealthCare Pharmaceuticals, Novo Nordisk

The peer reviewers and activity planners have no financial relationships to disclose.

Statement of Evidence-Based Content
Educational activities that assist physicians in carrying out their professional responsibilities more effectively and efficiently are consistent with the ACCME definition of continuing medical education (CME). As an ACCME-accredited provider of CME, it is the policy of Med-IQ to review and ensure that all the content and any recommendations, treatments, and manners of practicing medicine in CME activities are scientifically based, valid, and relevant to the practice of medicine. Med-IQ is responsible for validating the content of the CME activities it provides. Specifically, (1) all recommendations addressing the medical care of patients must be based on evidence that is scientifically sound and recognized as such within the profession; (2) all scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation must conform to generally accepted standards of experimental design, data collection, and analysis.
Med-IQ is not liable for any decision made or action taken in reliance upon the information provided through this activity.

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The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

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Complimentary CE
This activity is available free of charge to participants.

Acknowledgment of Support
This activity is funded in part by JDRF and The Leona M. and Harry B. Helmsley Charitable Trust.



Here are the key takeaways from this activity. Deeper insights and evidence, plus an opportunity to receive credit, are available by clicking the "Continue" button below.

  • Although HbA1c has long been recognized as the standard for measuring the glycemic control of people with diabetes, it does not provide any information about day-to-day glycemic variability or hypoglycemia frequency and severity
  • Glucose variability, time in range, and glucose management indicator also aid in assessing glycemic levels and informing treatment decisions for patients with T1D

Click "Continue" to proceed through this activity and/or receive credit.

By clicking "Continue," you confirm that you have reviewed the CME information.


Unless otherwise indicated, photographed subjects who appear within the content of this activity or on artwork associated with this activity are models; they are not actual patients or doctors.

The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

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