Achieved levels of HbA1c and likelihood of hospital admission in people with type 1 diabetes in the Scottish population: a study from the Scottish Diabetes Research Network Epidemiology Group

Lindsay Govan, Olivia Wu, Andrew Briggs, Helen M. Colhoun, Colin M. Fischbacher, Graham P. Leese, John A. McKnight, Sam Philip, Naveed Sattar, Sarah H. Wild, Robert S. Lindsay, Scottish Diabetes Research Network Epidemiology Group

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    Abstract

    OBJECTIVE-People with type 1 diabetes have increased risk of hospital admission compared with those without diabetes. We hypothesized that HbA(1c) would be an important indicator of risk of hospital admission.

    RESEARCH DESIGN AND METHODS-The Scottish Care Information Diabetes Collaboration, a dynamic national register of diagnosed cases of diabetes in Scotland, was linked to national data on admissions. We identified 24,750 people with type 1 diabetes during January 2005 to December 2007. We assessed the relationship between deciles of mean HbA(1c) and hospital admissions in people with type 1 diabetes adjusting for patient characteristics.

    RESULTS-There were 3,229 hospital admissions. Of the admissions, 8.1% of people had mean HbA(1c) <7.0% (53 mmol/mol) and 16.3% had HbA(1c) <7.5% (58 mmol/mol). The lowest odds of admission were associated with HbA(1c) 7.7-8.7% (61-72 mmol/mol). When compared with this decile, a J-shaped relationship existed between HbA(1c) and admission. The highest HbA(1c) decile (10.8-18.4%/95-178 mmol/mol) showed significantly higher odds ratio (95% CI) for any admission (2.80, 2.51-3.12); the lowest HbA(1c) decile (4.4-7.1%/25-54 mmol/mol) showed an increase in odds of admission of 1.29 (1.10-1.51). The highest HbA(1c) decile experienced significantly higher odds of diabetes-related (3.31, 2.94-3.72) and diabetes ketoacidosis admissions (10.18, 7.96-13.01).

    CONCLUSIONS-People with type 1 diabetes with highest and lowest mean HbA(1c) values were associated with increased odds of admission. People with high HbA(1c) (>10.8%/95 mmol/mol) were at particularly high risk. There is the need to develop effective interventions to reduce this risk.

    Original languageEnglish
    Pages (from-to)1992-1997
    Number of pages6
    JournalDiabetes Care
    Volume34
    Issue number9
    DOIs
    Publication statusPublished - Sep 2011

    Keywords

    • Retrospective cohort
    • Scotland
    • Mellitus

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