National initiatives lower HbA1c but further work needed to meet targets
medwireNews: Despite recent improvements in glycemic control, particularly among children and adolescents, the majority of people with type 1 diabetes in Scotland are still far from target glycated hemoglobin (HbA1c) levels, researchers report.
Helen Colhoun (The University of Edinburgh, UK) and colleagues say that “further improvement is badly needed,” especially among people from the most deprived areas.
Their analysis of 30,717 people with type 1 diabetes registered in the Scottish Care Information-Diabetes Collaboration database showed that median HbA1c decreased from 8.7% (72 mmol/mol) in 2004 to 8.4% (68 mmol/mol) in 2016.
The proportion of people with poor glycemic control (>9%, 75 mmol/mol) fell from 42% in 2004 to 36% in 2016, but the researchers note that the proportion below the NICE target of 6.5% (48 mmol/mol) was small and barely changed over time, from4% to 5%.
Analysis by year showed that all of the HbA1c improvement occurred during the last 4 years (2012–2016) of the study period. During this time, HbA1c levels fell by a significant 0.2% (3 mmol/mol), after adjustment for age, sex, age at diagnosis, treating health board, deprivation level, and season.
Colhoun and co-authors comment that this reduction coincided with national initiatives to reduce HbA1c, including an expansion of pump therapy, enhanced access to early structured education and psychological interventions, and increased provision of continuous glucose monitoring.
The researchers found that the largest reductions in HbA1c between 2012 and 2016 occurred in children (below age 13 years) and adolescents (age 13–18 years), with falls from 8.5% to 7.9% (69 to 63 mmol/mol) and from 9.0% to 8.6% (75 to 70 mmol/mol), respectively.
In spite of this, 16% of children and 42% of adolescents still had poor glycemic control in 2016, but the highest rate (48%) was seen in those aged 19–24 years.
“[T]hese data suggest a significant problem possibly initiated in but extending beyond the transition/transfer period,” Colhoun et al remark.
“Strategies to improve control in this vulnerable age group must address issues of healthcare disengagement, including new models of care, greater accessibility and wider availability of services such as clinical psychology.”
The team also observed large socioeconomic differences in HbA1c levels, with the 20% of people living in the most deprived areas having HbA1c levels on average 2.9% (8.0 mmol/mol) higher than the 20% of people living in the least deprived areas. Such differences “were apparent in all age groups” and “did not change significantly over time,” the researchers note.
Writing in Diabetologia, Colhoun et al conclude: “Greater efforts and use of recent innovations are needed to push further improvements in glycemic control in type 1 diabetes, with emphasis placed on strategies to reduce inequalities in health.”
By Laura Cowen
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