Factors Influencing Glycemic Control in Young People With Type 1 Diabetes in Scotland

Alexander, V; Blair, Alexander; Blair, Mitch; Campbell, Ian W; Collier, Andrew; Croll, Jillian; Connacher, A. A.; Craigie, I; Farmer, George; Fisher, M; Gallacher, S. J.; Gray, Stuart R.; Greene, S A; Harrower, A. D. B.; Jaapp, A.; Jung, R. T.; Kelnar, C. J. H.; Lawrence, Jean M.; Leese, Graham; Leslie, Peter; Louden, Mark L.; MacCuish, A C; Matthews, D. M.; MacRury, Sandra; McGregor, Mary; McKnight, John; McLaren, H. C.; McSporran, B; Morris, Andrew D.; Murchison, Lilian E.; Newton, R. W.; Noyes, Kathryn; O’Brien, Elizabeth; Patrick, A.W.; Patterson, Chris; Pearson, Donald; Peden, N. R.; Rae, Peter; Reith, Sebastian; Robertson, Kenneth; Rooney, David; Ruthven, Ian; Shepherd, Chelsea; Schulga, John; Smail, P J; Small, M.; Steel, Judith; Thompson, R.; Walker, James; Waugh, Norman

doi:10.2337/diacare.24.2.239

Cited by 107 publications

(20 citation statements)

References 14 publications

(10 reference statements)

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“…Older age, female sex, and longer diabetes duration were significantly associated with worse metabolic control, affirming previously reported findings (4,6–8,10,13–16,21,23–25). The varying quality of metabolic control may in part be attributable to differences in insulin sensitivity, treatment compliance, or insulin needs related to these factors.…”

Section: Discussionsupporting

confidence: 90%

“…Further, in the current study, improvement in average HbA 1c over time was comparable for different treatment regimens. This supports the view that other factors, such as the development of multidisciplinary diabetes care teams and improvements in structural quality of diabetes care and patient education, may have accounted for the observed trend (8,21,22). …”

Section: Discussionsupporting

confidence: 78%

“…The overall mean HbA 1c level (8.4%) and the proportion of patients with good (HbA 1c <7.5%, 33.7%) or poor metabolic control (HbA 1c >9.0%, 28.2%) in the study cohort were within the ranges found in several previous studies (5–8,13–15,21,23–25). …”

Section: Discussionsupporting

confidence: 77%

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Improved Metabolic Control in Children and Adolescents With Type 1 Diabetes

Rosenbauer

Dost²,

Karges³

et al. 2011

Diabetes Care

254

222

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OBJECTIVETo investigate the temporal trend of metabolic control and potential predictors in German and Austrian children and adolescents with type 1 diabetes.RESEARCH DESIGN AND METHODSThis study is based on a large, multicenter database for prospective longitudinal documentation of diabetes care in Germany and Austria. Data from 30,708 patients documented in 305 diabetes centers between 1995 and 2009 were analyzed. Generalized linear mixed regression models were used to adjust trend analysis for relevant confounders.RESULTSUnadjusted mean HbA1c decreased from 8.7 ± 1.8% in 1995 to 8.1 ± 1.5% in 2009. In multiple regression analysis, treatment year, age, sex, diabetes duration, migration background, BMI-SDS, and daily insulin dose were significant predictors of metabolic control (P < 0.001). After multiple adjustment, mean HbA1c decreased significantly by 0.038% per year (95% CI 0.032–0.043%), average odds ratio (OR) per year for HbA1c >7.5% (>9.0%) was 0.969 (95% CI 0.961–0.977) (0.948, 95% CI 0.941–0.956). Intensified insulin regimen was associated with lower frequency of poor metabolic control (HbA1c >9%; P = 0.005) but not with average HbA1c (P = 0.797). Rate of severe hypoglycemia and hypoglycemic coma decreased significantly (relative risk [RR] per year 0.948, 95% CI 0.918–0.979; RR 0.917, 95% CI 0.885–0.950) over the study period. Diabetic ketoacidosis rate showed no significant variation over time.CONCLUSIONSThis study showed a significant improvement in metabolic control in children and adolescents with type 1 diabetes during the past decade and a simultaneous decrease in hypoglycemic events. The improvement was not completely explained by changes in the mode of insulin treatment. Other factors such as improved patient education may have accounted for the observed trend.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 78%

See 1 more Smart Citation

Improved Metabolic Control in Children and Adolescents With Type 1 Diabetes

Rosenbauer

Dost²,

Karges³

et al. 2011

Diabetes Care

254

222

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show abstract

“…16 Likewise, the Diabaud 2 study found significant differences in HbA1c between 18 Scottish paediatric diabetes centres, also suggesting that care in some centres was better than others. 17 Deployment of resources, organisation of the clinic and strategies of medical care were suggested as possible reasons for the differences, but these factors could not be quantified by the study. Cultural factors have also been suggested as a significant factor affecting outcomes between centres.…”

Section: Which Factors Contribute To Better Care?mentioning

confidence: 94%

“…12 National audits of children's diabetes services and outcomes have revealed important data in the past, but in Scotland this has not been an ongoing audit. 3,17 To be fully effective it should be carried out continuously, be co-ordinated by a national body (for example, Paediatric Diabetes MCN) and be fully supported financially by the government.…”

Section: Evaluating Healthcarementioning

confidence: 99%

The best model of care for children and young people with diabetes

Williamson¹

2010

JRCPE

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introDUCtionThe incidence of diabetes in childhood has been rising by 3.9% each year in Europe in recent years.1 This has been higher in the pre-school age group, where the incidence is predicted to double by 2020 from its 2005 figure.1 Young people (defined as individuals between the ages of 11 and 18 years 2 ) with diabetes struggle to attain the standards for glycaemic control set for them.3,4 They have a high mortality, 5 develop long-term complications at a relatively early age 6 and have high rates of mental health problems. 7 These factors challenge health services to find the best way of caring for increasing numbers of children and young people with diabetes, so the best model of care needs to be clearly defined. This paper summarises the available evidence and expert opinion on the factors that may contribute to the best model of care for children and young people with diabetes. What is a 'model of care'?A clear definition of 'model of care' is hard to find in the medical literature. Examples include: 'an overarching design for the provision of a particular type of health care service that is shaped by a theoretical basis, evidence based practice and defined standards' 8 and 'a multifaceted concept, which broadly defines the way health services are delivered'. 9 The main theme of these definitions is the provision, or delivery, of healthcare. Delivery of healthcare has three components: structure, process and outcome. 10 Structural data are characteristics of personnel and hospitals or clinics. With these a framework is created from which to deliver the process. Process data are the components of the encounter between a doctor or another healthcare professional and a patient (e.g. teaching carbohydrate counting or using a particular insulin regime). The process is intended to create a beneficial effect on outcomes. Outcome data refer to the patient's subsequent health status (e.g. glycosylated haemoglobin, HbA1c, or frequency of hypoglycaemia).A simple definition of the term 'model of care' would therefore be: 'The structures of healthcare and the processes they deliver.' What models of care are used for childhood diabetes?In the UK, children with diabetes in the most part have their care delivered by specific professionals based within secondary care.11 This has been directed by consensus agreements such as the St Vincent declaration and the recommendations of the British Paediatric Association in 1990, 12,13 but it relies on the structures underpinning the secondary healthcare services, which are not specifically designed for chronic care so may have a number of shortcomings. Models of care for childhood diabetes have evolved slowly from this by adopting novel 'processes' into slowly adapting structures (e.g. implementing intensive insulin therapy, then slowly increasing the numbers of nursing staff available to deliver it), rather than making radical changes to structures to enable the most efficient delivery of the process. We therefore do not find radically different models of care for childhood d...

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Current Awareness

2001

Diabetes Metab. Res. Rev.

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In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of diabetes/metabolism. Each bibliography is divided into 17 sections: 1 Books, Reviews & Symposia; 2 General; 3 Genetics; 4 Epidemiology; 5 Immunology; 6 Prediction; 7 Prevention; 8 Intervention: a) General; b) Pharmacology; 9 Pathology: a) General; b) Cardiovascular; c) Neurological; d) Renal; 10 Endocrinology & Metabolism; 11 Nutrition; 12 Animal Studies; 13 Techniques. Within each section, articles are listed in alphabetical order with respect to author (9 Weeks journals ‐ Search completed at 9th Mar. 2001)

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Factors Influencing Glycemic Control in Young People With Type 1 Diabetes in Scotland

Cited by 107 publications

References 14 publications

Improved Metabolic Control in Children and Adolescents With Type 1 Diabetes

Improved Metabolic Control in Children and Adolescents With Type 1 Diabetes

The best model of care for children and young people with diabetes

Current Awareness

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