Factors influencing glycemic control in young people with type 1 diabetes in Scotland - A population-based study (DIABAUD2)

OBJECTIVE- To evaluate differences in HbA(1c) concentrations between center s and to assess the factors associated with glycemic control in young peopl e with type 1 diabetes in Scotland. RESEARCH DESIGN AND METHODS- Data on 1,755 patients (94% of those registere d) were collected from 18 centers providing care to children <15 years of a ge. At every clinic visit, a duplicate HbA(1c) sample was measured in a ref erence laboratory, and clinical information was collected prospectively. RESULTS- Average HbA(1c) concentration was 9.1% (range 5.0-15.0). The follo wing significant associations with HbA(1c) level were identified: age, insu lin regimen, BMI, season, social circumstances, and family history. HbA(1c) 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 his tory 9.1%, P < 0.001). HbA(1c) concentration ranged from 8.1 to 10.2% betwe en centers, after adjustment for factors associated with poor HbA(1c) (P < 0.001). CONCLUSIONS- The overall glycemic control of diabetic young people in Scotl and is equivalent to a Diabetes Control and Complications Trial HbA(1c) con centration of 8.7%, placing the majority at a high risk of the complication s of diabetes in adulthood. Although factors were significantly associated with poor HbA(1c), adjustment for these did not explain the differences bet ween centers. We suggest that factors not analyzed in DIABAUD2 (e.g., deplo yment of resources, organization of the clinical structure, strategies of c are, and clinic philosophy) are the determinants of HbA(1c). We speculate t hat the style of utilization of optimum resources is the key to achieving g ood glycemic control.