How well are we doing? – Metabolic control in patients with diabetes

Thomsett, MJ; Shield, G. J.; Batch, JA; Cotterill, A M

doi:10.1046/j.1440-1754.1999.355424.x

Cited by 34 publications

(27 citation statements)

References 10 publications

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“…In our audit of 1190 children, longer diabetes duration was a predictor of higher HbA 1c level, and an elevated HbA 1c level (> 8%) is a known risk factor for microvascular complications 2 . Our participants' median HbA 1c level of 8.2%, with a median duration of diabetes of three years, is comparable to that found in the multicentre Hvidore Study 3 (DCCT equivalent, 8.3%) and in a Brisbane clinic‐based study 11 (mean HbA 1c level, 8.6%, determined by several assay methods). However, six years after diagnosis of type 1 diabetes in childhood, early microvascular complications were found in 34% of an incident cohort from NSW, whose median HbA 1c level was 8.7% 12 …”

Section: Discussionsupporting

confidence: 79%

Predictors of glycaemic control and hypoglycaemia in children and adolescents with type 1 diabetes from NSW and the ACT

Craig

Handelsman

Donaghue

et al. 2002

Medical Journal of Australia

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Objectives: To audit glycaemic control and incidence of severe hypoglycaemia in children and adolescents with type 1 diabetes in New South Wales (NSW) and the Australian Capital Territory (ACT). Design: A multicentre, population‐based, cross‐sectional study from 1 September to 31 December, 1999. Participants: 1190 children and adolescents aged 1.2–15.8 years with type 1 diabetes, identified from three hospital‐based paediatric diabetes units, four private city‐based paediatric practices and 18 regional outreach clinics in NSW and the ACT. Main outcome measures: HbA1c level and incidence of severe hypoglycaemia (defined by unconsciousness or seizures). Results: The response rate was 67% (1190 of a target group of 1765). The median HbA1c level was 8.2% (interquartile range, 7.6%–9.1%). Significant predictors of HbA1c level in a multiple regression model were duration (b = 0.05; 95% CI, 0.02–0.07) and insulin dose/kg (b = 0.46; 95% CI, 0.27–0.66). At least one episode of severe hypoglycaemia in the previous three months was reported in 6.7%, and the rate of severe hypoglycaemia was 36/100 patient‐years. Significant predictors of hypoglycaemia in a Poisson regression model were younger age (P = 0.03), male sex (P = 0.04), longer diabetes duration (P = 0.02), and > 3 daily insulin injections (P = 0.02), but not HbA1c level. Children with diabetes had higher BMI standard deviation scores compared with population standards, and those in the highest quartile of BMI standard deviation score were younger, had shorter diabetes duration and had higher HbA1c level. Conclusions: Many children and adolescents with type 1 diabetes have suboptimal glycaemic control, placing them at high risk of developing microvascular complications. Those with longer diabetes duration are at increased risk of suboptimal glycaemic control and severe hypoglycaemia and should be targeted for interventional strategies.

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Section: Discussionsupporting

confidence: 79%

Predictors of glycaemic control and hypoglycaemia in children and adolescents with type 1 diabetes from NSW and the ACT

Craig

Handelsman

Donaghue

et al. 2002

Medical Journal of Australia

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“…In this study of a randomly selected cohort within the RCH diabetes clinic, the overall level of metabolic control was similar to our diabetes clinic average (8.2–8.6%). Moreover, the mean HbA 1c level was identical to those reported from other areas of Australia and international diabetes care centres 21,22 . Thus, we feel that our cohort is a reasonably representative sample of an ‘average’ paediatric diabetes population.…”

Section: Discussionsupporting

confidence: 77%

Satisfaction of care in a tertiary level diabetes clinic: Correlations with diabetes knowledge, clinical outcome and health‐related quality of life

Koves¹,

Boucher²,

Ismail³

et al. 2008

J Paediatrics Child Health

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“…This, however, was found to occur in only seven patients. The levels of control seen in both relapsers and non‐relapsers were significantly worse than cross‐sectional mean HbA1C reports of 8.6% seen in other Australian and international centres (26–28) and it is likely that rates of insulin omission leading to DKA were higher than those recorded.…”

Section: Discussionmentioning

confidence: 60%

Trends in diabetic ketoacidosis in childhood and adolescence: a 15-yr experience

2002

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The number of episodes of diabetic ketoacidosis (DKA) is a significant outcome measure for diabetes care. We ascertained patterns of admission due to DKA over 15 yr to determine whether this indicator of diabetes care had improved in parallel with clinical practices. Between 1 January 1985 and 31 December 1999, 630 admissions were reviewed. We subanalyzed these admissions according to whether the patient was newly diagnosed, had infrequent episodes of DKA (non-relapsers) or had frequent (> or = 2/yr) episodes of DKA (relapsers). Overall there was a slight downward trend in the incidence of DKA admissions over the study period. There was a proportionate increase in the incidence of DKA amongst newly diagnosed patients, with a proportionate decrease in the incidence of DKA seen in relapsers. DKA occurring in non-relapsers remained relatively stable. Adverse clinical events during the admission were relatively uncommon and occurred in all three subgroups. There was no significant difference in HbA1C prior to admission between the relapser and non-relapser groups and there was similarity in the degree of acidosis between all three subgroups. The frequency of significant complications associated with DKA remained unchanged over the study period. Slower rehydration policies were not associated with decreases in either cerebral edema or death rates. DKA remains a significant complication of type 1 diabetes associated with a variety of significant adverse events. Our experience indicates that further efforts to reduce the occurrence of DKA must be focused upon earlier diagnosis and intervention in newly diagnosed patients.

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How well are we doing? – Metabolic control in patients with diabetes

Abstract: Only 33% of patients had a HbA1C concentration less than 8% and 6.3% had a severe hypoglycaemic episode in the 3 months. These results are similar to published overseas data.

Cited by 34 publications

References 10 publications

Predictors of glycaemic control and hypoglycaemia in children and adolescents with type 1 diabetes from NSW and the ACT

Predictors of glycaemic control and hypoglycaemia in children and adolescents with type 1 diabetes from NSW and the ACT

Satisfaction of care in a tertiary level diabetes clinic: Correlations with diabetes knowledge, clinical outcome and health‐related quality of life

Trends in diabetic ketoacidosis in childhood and adolescence: a 15-yr experience

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