356Impact of site-specific and patient-specific factors in explaining HbA1c variation in Australian diabetes centres

Abstract

Abstract Background Management of glycaemia remains the mainstay of optimal diabetes care. As reported by the Australian National Diabetes Audit (ANDA) average glycaemia is suboptimal for many people living with diabetes. Whether centre-specific factors influence HbA1c variation among patients attending Australian primary, secondary or tertiary diabetes centres, is not known. Methods Data for 5,872 people with Type 1 or Type 2 diabetes (DM1/DM2) was collected for ANDA over a 4-6 week period. A linear mixed-effects model was built to examine the relative contribution of centre-specific (type of centre, location and volume of patients) and patient-specific factors in explaining variation in HbA1c, by diabetes type. Results Mean age of the cohort was 57.5±17.2 years, median disease duration 14 years (7,21) with 47% female. For people with DM1, number of patients was the only centre-specific factor that significantly contributed to HbA1c variation (p = 0.019). In contrast, for people with DM2, type of centre significantly contributed toHbA1c variation (p < 0.001). Patient-specific factors contributing to HbA1c variation included prior hyperglycaemic emergencies, being a non-smoker and Aboriginal or Torres Strait Islander status. Conclusions Unlike patient factors, centre factors such as type, location and volume of patients appear to have less actionable impact on HbA1c variation. Key messages Centre-level interventions to target patient-specific factors (such as sick day management education to prevent acute hyperglycaemia, smoking cessation programs and culturally appropriate diabetes education) rather than centre-specific factors may be more important for improving glycaemia.