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

Abstract

OBJECTIVE— To evaluate differences in HbA_lc concentrations between centers and to assess the factors associated with glycemic control in young people with type 1 diabetes in Scotland.

RESEARCH DESIGN AND METHODS— Data on 1,755 patients (94% of those registered) were collected from 18 centers providing care to children <15 years of age. At every clinic visit, a duplicate HbA_lc sample was measured in a reference laboratory, and clinical information was collected prospectively.

RESULTS— Average HbA_lc concentration was 9.1% (range 5.0-15.0). The following significant associations with HbA_lc level were identified: age, insulin regimen, BMI, season, social circumstances, and family history. HbA_lc concentrations were significantly worse in older children (age 10-15 years 9.5% vs. other ages 8.8%, P < 0.001), those using two injections per day (2/day 9.1% vs. 3/day 8.8%, P < 0.01), children without both parents at home (9.4 vs. 9.0%, P < 0.001), a sibling with diabetes (9.7% vs. no family history 9.1%, P < 0.001). HbA_lc concentration ranged from 8.1 to 10.2% between centers, after adjustment for factors associated with poor HbA_lc (P < 0.001).

CONCLUSIONS— The overall glycemic control of diabetic young people in Scotland is equivalent to a Diabetes Control and Complications Trial HbA_lc concentration of 8.7%, placing the majority at a high risk of the complications of diabetes in adulthood. Although factors were significantly associated with poor HbA_lc, adjustment for these did not explain the differences between centers. We suggest that factors not analyzed in DIABAUD2 (e.g., deployment of resources, organization of the clinical structure, strategies of care, and clinic philosophy) are the determinants of HbA_lc. We speculate that the style of utilization of optimum resources is the key to achieving good glycemic control.