Glycated haemoglobin and metabolic control of diabetes mellitus: external versus locally established clinical targets for primary care

Butler, Christopher; Peters, John R.; Stott, N. C. H.

doi:10.1136/bmj.310.6982.784

Cited by 28 publications

(20 citation statements)

References 19 publications

(24 reference statements)

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“…Record linkage has been described previously (17), but we have recently extended the process to incorporate a wider range of data sources over a longer time period. Briefly, inpatient records (1991)(1992)(1993)(1994)(1995)(1996)(1997), outpatient data (1991)(1992)(1993)(1994)(1995)(1996), a diabetic outpatient clinic database (ongoing since 1993), mortality data (1993)(1994)(1995)(1996)(1997), and a general practice diabetes audit database (1996) covering Ͼ80% of the district population (18,19) were used. These data sources were combined using probabilistic algorithms to identify all records relating to unique individuals and also to identify patients with a diagnosis of diabetes from 1 of 4 sources: 1) an immediate or antecedent cause of death on the mortality dataset (ICD-9 classification, 250); 2) an inpatient record with a diagnosis of diabetes recorded in 1 of 6 diagnostic fields (ICD-9 classification, 250; International…”

Section: Research Design and Methods -mentioning

confidence: 99%

Relationship between diabetes and mortality: a population study using record linkage.

2000

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A population study using record linkage O R I G I N A L A R T I C L EOBJECTIVE -To determine patterns and causes of mortality for patients with diabetes in a district health authority.RESEARCH DESIGN AND METHODS -The study used cross-sectional record linkage, combining an electronic death register with a diabetic patient register constructed from a variety of routine health data sources collected from 1991 to 1997. The study was conducted in Cardiff and the Vale of Glamorgan, Wales, U.K., and included all diabetic deaths between 1993 and 1996.RESULTS -Of 1,694 deaths in patients with known diabetes, only 674 (39.8%) had diabetes recorded as an immediate or antecedent cause of death. Mortality rates were 41.8 per 1,000 for the diabetic population and 10.1 per 1,000 for the nondiabetic population. The standard mean ratio for the diabetic population was 1.24 (95% CI 1.12-1.35), with the risk of mortality relative to the nondiabetic population decreasing with age. Males with diabetes lost an average of 7.0 years from the year of diagnosis, and females with diabetes lost an average of 7.5 years. The most common cause of death was cardiovascular disease, which accounted for 49.1% of deaths in the diabetic population.CONCLUSIONS -Diabetes is recorded as a cause of death on a minority of death certificates for patients with diabetes. Using death certificates in isolation, therefore, is a poor method of estimating diabetic mortality, but results can be improved with the use of record linkage techniques. Patients with diabetes have an excess risk of mortality compared with the nondiabetic population. Life-years lost for patients with diabetes is strongly related to age at diagnosis and is a means of expressing mortality without relying on accurate prevalence data.

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Section: Research Design and Methods -mentioning

confidence: 99%

Relationship between diabetes and mortality: a population study using record linkage.

2000

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“…After the IDDM children group classification following the criteria of the American and British Associations for IDDM metabolic control (Butler et al, 1995), the results obtained in our groups means that 53% of the patients included in our study had poor metabolic control of their illness, 26% of the patients presented moderate metabolic control of their diabetes and 21% of the IDDM children showed good metabolic control. Table 2 shows the statistical differences found between the two groups for the biochemical parameters studied.…”

Section: Resultsmentioning

confidence: 92%

“…Following the American and British Associations for IDDM metabolic control (Butler et al, 1995), based on HbA1c levels, the IDDM children were classified as follows:…”

Section: Subjectsmentioning

confidence: 99%

Vitamin A, retinol binding protein and lipids in type 1 diabetes mellitus

et al. 2002

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Objective: A case -control study was conducted to evaluate the effects of type 1 diabetes mellitus (IDDM) on plasma levels of vitamin A (retinol) and serum levels of retinol-binding protein (RBP) and their relationship with the atherogenic indicators. Subjects: A total of 47 randomised IDDM children were recruited from those treated at the Endocrinology Unit of the University Hospital of Granada (Spain). They were matched for age and sex with 16 healthy children. Methods: The following parameters were measured in all patients: serum concentrations of total cholesterol, triglycerides, high (HDL, spectrophotometry), very low (VLDL) and low (LDL) density lipoprotein cholesterol (Friedewald's formula); serum levels of RBP (kinetic nephelometry); plasma vitamin A and glycosilated haemoglobin (HbA1c; high performance chromatography). Results: Higher RBP concentrations in IDDM children (P ¼ 0.05), lower retinol levels (P ¼ 0.05) and lower vitamin A=cholesterol ratio (P ¼ 0.02) than in the control group were found; no differences in the atherogenic indicators were observed. There was a correlation between RBP and vitamin A (P ¼ 0.0001). Relationships between retinol, RBP and atherogenic indicators were demonstrated in the IDDM group (A-LDLc=HDLc (P ¼ 0.01); A-(VLDL þ LDL)c=HDLc (P ¼ 0.007); RBP-LDLc=HDLc (P ¼ 0.05); RBP-(VLDL þ LDL)c=HDLc (P ¼ 0.02)), and an inverse relationship was found between the vitamin A=TG ratio and HbA1c (P ¼ 0.004). The children with HbA1c > 8% showed increased atherogenic indicators and lower vitamin A=CHOL and vitamin A=TG ratios than those with good control of the illness. Conclusions: The IDDM children with poor metabolic control face a higher atherogenic risk and vitamin A 'relative deficiency' risk than those with good metabolic control of their illness. Relationships between retinol and RBP with atherogenic indicators were found. The results suggest that vitamin A therapeutic supplements in IDDM children may reduce or prevent atherogenic risk.

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“…5 Reviews took place between annual assessments. 1 In the first 1-year group we did not collect information on treatment to lower blood glucose.…”

Section: Patient Outcome Measuresmentioning

confidence: 99%

Encouraging structured personalised diabetes care in general practice

Hansen

Olivarius

Siersma

et al. 2003

Scandinavian Journal of Primary Health Care

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Glycated haemoglobin and metabolic control of diabetes mellitus: external versus locally established clinical targets for primary care

Cited by 28 publications

References 19 publications

Relationship between diabetes and mortality: a population study using record linkage.

Relationship between diabetes and mortality: a population study using record linkage.

Vitamin A, retinol binding protein and lipids in type 1 diabetes mellitus

Encouraging structured personalised diabetes care in general practice

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