Health Inequities in Older Adults With Type 1 Diabetes: A Nationwide Registry Analysis of Sociodemographic and Clinical Profiles for Glycaemic Control and Complications

ABSTRACT Aims Despite its rising prevalence, older adults with Type 1 diabetes remain poorly characterised. This study aimed to characterise those over 60 years and quantify independent predictors of glycaemic control and complications. Materials and Methods We performed a multicentre analysis using real‐world data from the China Diabetes Type 1 Study (CD1S), including 69 centres across China between 2016 and 2021. Patients were stratified into three age groups (≥ 60, 18–59 and < 18 years) for assessment of clinical characteristics and complications. Multiple regression examined associations of clinical features with HbA1c and complications. Variable importance was interpreted using SHAP values derived from a random forest model. Results We enrolled 9637 patients with Type 1 diabetes. Compared with young adults, older adults with Type 1 diabetes were less likely to achieve target HbA1c (7.2% vs. 10.2%, p < 0.05) and had a substantially higher burden of chronic complications, with 81.0% of older adults having at least one complication. Longer duration, higher BMI and higher gross domestic product (GDP) were significantly associated with lower HbA1c (all p < 0.05). Higher GDP was linked to reduced rates of diabetic retinopathy (19.7%), nephropathy (13.6%) and peripheral neuropathy (46.9%), yet a higher proportion of peripheral vasculopathy (41.8%) was observed compared with middle‐ and low‐GDP regions. Conclusions Older adults with Type 1 diabetes exhibit a unique clinical profile of poor glycaemic control and a high burden of complications, influenced by regional GDP disparities. This underscores the critical need to integrate socioeconomic factors into personalised care strategies to advance health equity. Registration number: NCT05498974.