Abstract
Aims/hypothesisThe aim of this work was to examine whether glycaemic control has improved in those with type 1 diabetes in Scotland between 2004 and 2016, and whether any trends differed by sociodemographic factors.MethodsWe analysed records from 30,717 people with type 1 diabetes, registered anytime between 2004 and 2016 in the national diabetes database, which contained repeated measures of HbA1c. An additive mixed regression model was used to estimate calendar time and other effects on HbA1c.ResultsOverall, median (IQR) HbA1c decreased from 72 (21) mmol/mol [8.7 (4.1)%] in 2004 to 68 (21) mmol/mol (8.4 [4.1]%) in 2016. However, all of the improvement across the period occurred in the latter 4 years: the regression model showed that the only period of significant change in HbA1c was 2012–2016 where there was a fall of 3 (95% CI 1.82, 3.43) mmol/mol. The largest reductions in HbA1c in this period were seen in children, from 69 (16) mmol/mol (8.5 [3.6]%) to 63 (14) mmol/mol (7.9 [3.4]%), and adolescents, from 75 (25) mmol/mol (9.0 [4.4]%) to 70 (23) mmol/mol (8.6 [4.3]%). Socioeconomic status (according to Scottish Index of Multiple Deprivation) affected the HbA1c values: from the regression model, the 20% of people living in the most-deprived areas had HbA1c levels on average 8.0 (95% CI 7.4, 8.9) mmol/mol higher than those of the 20% of people living in the least-deprived areas. However this difference did not change significantly over time. From the regression model HbA1c was on average 1.7 (95% CI 1.6, 1.8) mmol/mol higher in women than in men. This sex difference did not narrow over time.Conclusions/interpretationIn this high-income country, we identified a modest but important improvement in HbA1c since 2012 that was most marked in children and adolescents. These changes coincided with national initiatives to reduce HbA1c including an expansion of pump therapy. However, in most people, overall glycaemic control remains far from target levels and further improvement is badly needed, particularly in those from more-deprived areas.
Highlights
Type 1 diabetes is associated with a substantial reduction in life span [1] and a threefold increase in the rate of cardiovascular disease compared with individuals without diabetes and remains a common cause of end-stage renal disease and loss of vision [2]
Socioeconomic status affected the HbA1c values: from the regression model, the 20% of people living in the most-deprived areas had HbA1c levels on average 8.0 mmol/mol higher than those of the 20% of people living in the least-deprived areas
A national survey showed that the proportion of individuals with type 1 diabetes who achieved HbA1c ≤58 mmol/mol (7.5%) in Scotland slightly improved from 21.5% in 2013 to 24.5% in 2016 [6]
Summary
Type 1 diabetes is associated with a substantial reduction in life span [1] and a threefold increase in the rate of cardiovascular disease compared with individuals without diabetes and remains a common cause of end-stage renal disease and loss of vision [2]. In an international study of type 1 diabetes in 19 countries in 2014, most people with type 1 diabetes had higher than recommended levels of HbA1c [4] Of those aged 15 years and more, median levels of HbA1c were highest in Scotland. A national survey showed that the proportion of individuals with type 1 diabetes who achieved HbA1c ≤58 mmol/mol (7.5%) in Scotland slightly improved from 21.5% in 2013 to 24.5% in 2016 [6]. This survey reports the overall population HbA1c annually but does not test whether year-on-year changes represent significant trends or random fluctuations and does not explore detailed trends by age, sex or socioeconomic strata. We sought evidence of whether healthcare innovations have had any impact on HbA1c in this highincome country
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