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

TY - JOUR

T1 - Achieved levels of HbA1c and likelihood of hospital admission in people with type 1 diabetes in the Scottish population

T2 - a study from the Scottish Diabetes Research Network Epidemiology Group

AU - Govan, Lindsay

AU - Wu, Olivia

AU - Briggs, Andrew

AU - Colhoun, Helen M.

AU - Fischbacher, Colin M.

AU - Leese, Graham P.

AU - McKnight, John A.

AU - Philip, Sam

AU - Sattar, Naveed

AU - Wild, Sarah H.

AU - Lindsay, Robert S.

AU - Scottish Diabetes Research Network Epidemiology Group

PY - 2011/9

Y1 - 2011/9

N2 - 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.

AB - 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.

KW - Retrospective cohort

KW - Scotland

KW - Mellitus

U2 - 10.2337/dc10-2099

DO - 10.2337/dc10-2099

M3 - Article

C2 - 21788623

SN - 0149-5992

VL - 34

SP - 1992

EP - 1997

JO - Diabetes Care

JF - Diabetes Care

IS - 9

ER -