TY - JOUR
T1 - Glycaemic control trends in people with Type 1 diabetes in Scotland 2004-2016
AU - Scottish Diabetes Research Network Epidemiology Group
AU - Mair, Colette
AU - Wulaningsih, Wahyu
AU - Jeyam, Anita
AU - McGurnaghan, Stuart
AU - Blackbourn, Luke A. K.
AU - Kennon, Brian
AU - Leese, Graham
AU - Lindsay, Robert
AU - McCrimmon, Rory
AU - McKnight, John A.
AU - Petrie, John R.
AU - Sattar, Naveed
AU - Wild, Sarah H.
AU - Conway, Nicholas
AU - Craigie, Ian
AU - Robertson, Kenneth
AU - Bath, Louise
AU - McKeigue, Paul M.
AU - Colhoun, Helen M.
N1 - We are grateful to Diabetes UK (17/0005627) and the Chief Scientist Office (ETM/47) for funding this work.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - Aims/hypothesis: The aim of this work was to examine whether glycaemic control has improved in those with type 1 diabetes in Scotland between 2004 and 2016, and whether any trends differed by sociodemographic factors.Methods: We analysed records from 30,717 people with type 1 diabetes, registered anytime between 2004 and 2016 in the national diabetes database, which contained repeated measures of HbA 1c. An additive mixed regression model was used to estimate calendar time and other effects on HbA 1c.Results: Overall, median (IQR) HbA 1c decreased from 72 (21) mmol/mol [8.7 (4.1)%] in 2004 to 68 (21) mmol/mol (8.4 [4.1]%) in 2016. However, all of the improvement across the period occurred in the latter 4 years: the regression model showed that the only period of significant change in HbA 1c was 2012–2016 where there was a fall of 3 (95% CI 1.82, 3.43) mmol/mol. The largest reductions in HbA 1c in this period were seen in children, from 69 (16) mmol/mol (8.5 [3.6]%) to 63 (14) mmol/mol (7.9 [3.4]%), and adolescents, from 75 (25) mmol/mol (9.0 [4.4]%) to 70 (23) mmol/mol (8.6 [4.3]%). Socioeconomic status (according to Scottish Index of Multiple Deprivation) affected the HbA 1c values: from the regression model, the 20% of people living in the most-deprived areas had HbA 1c levels on average 8.0 (95% CI 7.4, 8.9) mmol/mol higher than those of the 20% of people living in the least-deprived areas. However this difference did not change significantly over time. From the regression model HbA 1c was on average 1.7 (95% CI 1.6, 1.8) mmol/mol higher in women than in men. This sex difference did not narrow over time.Conclusions/interpretation: In this high-income country, we identified a modest but important improvement in HbA 1c since 2012 that was most marked in children and adolescents. These changes coincided with national initiatives to reduce HbA 1c including an expansion of pump therapy. However, in most people, overall glycaemic control remains far from target levels and further improvement is badly needed, particularly in those from more-deprived areas.
AB - Aims/hypothesis: The aim of this work was to examine whether glycaemic control has improved in those with type 1 diabetes in Scotland between 2004 and 2016, and whether any trends differed by sociodemographic factors.Methods: We analysed records from 30,717 people with type 1 diabetes, registered anytime between 2004 and 2016 in the national diabetes database, which contained repeated measures of HbA 1c. An additive mixed regression model was used to estimate calendar time and other effects on HbA 1c.Results: Overall, median (IQR) HbA 1c decreased from 72 (21) mmol/mol [8.7 (4.1)%] in 2004 to 68 (21) mmol/mol (8.4 [4.1]%) in 2016. However, all of the improvement across the period occurred in the latter 4 years: the regression model showed that the only period of significant change in HbA 1c was 2012–2016 where there was a fall of 3 (95% CI 1.82, 3.43) mmol/mol. The largest reductions in HbA 1c in this period were seen in children, from 69 (16) mmol/mol (8.5 [3.6]%) to 63 (14) mmol/mol (7.9 [3.4]%), and adolescents, from 75 (25) mmol/mol (9.0 [4.4]%) to 70 (23) mmol/mol (8.6 [4.3]%). Socioeconomic status (according to Scottish Index of Multiple Deprivation) affected the HbA 1c values: from the regression model, the 20% of people living in the most-deprived areas had HbA 1c levels on average 8.0 (95% CI 7.4, 8.9) mmol/mol higher than those of the 20% of people living in the least-deprived areas. However this difference did not change significantly over time. From the regression model HbA 1c was on average 1.7 (95% CI 1.6, 1.8) mmol/mol higher in women than in men. This sex difference did not narrow over time.Conclusions/interpretation: In this high-income country, we identified a modest but important improvement in HbA 1c since 2012 that was most marked in children and adolescents. These changes coincided with national initiatives to reduce HbA 1c including an expansion of pump therapy. However, in most people, overall glycaemic control remains far from target levels and further improvement is badly needed, particularly in those from more-deprived areas.
KW - Additive mixed regression
KW - Glycaemic control
KW - HbA
KW - Insulin
KW - Type 1 diabetes
UR - http://www.scopus.com/inward/record.url?scp=85066095527&partnerID=8YFLogxK
U2 - 10.1007/s00125-019-4900-7
DO - 10.1007/s00125-019-4900-7
M3 - Article
C2 - 31104095
SN - 0012-186X
VL - 62
SP - 1375
EP - 1384
JO - Diabetologia
JF - Diabetologia
IS - 8
ER -
