Glycaemic control in a type 1 diabetes clinic for younger adults

S A Saunders, M Wallymahmed, I A MacFarlane

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)

Abstract

BACKGROUND: In the Diabetes Control and Complications Trial (DCCT, 1993) tight diabetes control (HbA1c <7%) was associated with significantly less microvascular complications compared to 'conventionally' treated type 1 patients.

AIM: To assess the effectiveness of a dedicated young-adult type 1 diabetes clinic in achieving HbA1c levels <7% between 1991 and 2001.

DESIGN: Retrospective review of case-notes.

METHODS: All patients who attended the clinic in the first six years (1991 to 1996) were studied. All were offered at least two appointments per year. Case-notes were reviewed up to December 2001.

RESULTS: We treated 386 type 1 patients (59.8% male, mean age 28.7 years, mean duration diabetes 9.5 years). After a mean follow-up of 7.7 years, 261 (67.6%) had attended in the past 2 years, 22 (5.8%) were known to have died, 11 (2.8%) had transferred to another clinic and 92 (23.8%) had repeatedly failed to attend appointments for 2 years. Over 11 years, the total mean (SD) HbA1c was 9.19% (1.3). Only 3.4% of patients achieved an average HbA1c of <7% during the study period, and 80% of patients had average HbA1c levels of >8%.

DISCUSSION: Despite regular specialist physician, specialist diabetes nurse and dietician input, encouragement of multiple daily insulin injections and repeatedly following-up failed appointments (including home visits), fewer than 1:20 patients achieved the DCCT target of mean HbA1c <7%. Tight diabetes control is rare in a routine clinic setting.

Original languageEnglish
Pages (from-to)575-80
Number of pages6
JournalQJM - Monthly Journal of the Association of Physicians
Volume97
Issue number9
Early online date1 Sep 2004
DOIs
Publication statusPublished - Sep 2004

Keywords

  • Adult
  • Diabetes Mellitus, Type 1/blood
  • Diabetic Angiopathies/blood
  • Diabetic Ketoacidosis/diagnosis
  • Female
  • Glycated Hemoglobin A/analysis
  • Humans
  • Hypoglycemia/etiology
  • Insulin/administration & dosage
  • Male
  • Patient Compliance
  • Retrospective Studies
  • Time Factors

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