Glycaemic control in a type 1 diabetes clinic for younger adults.
BACKGROUND
In the Diabetes Control and Complications Trial (DCCT, 1993) tight diabetes control (HbA1c <7%) was associated with significantly less microvascular complications compared to 'conventionally' treated type 1 patients.


OBJECTIVE
To assess the effectiveness of a dedicated young-adult type 1 diabetes clinic in achieving HbA1c levels <7% between 1991 and 2001.


METHODS
Retrospective review of case-notes.


METHODS
All patients who attended the clinic in the first six years (1991 to 1996) were studied. All were offered at least two appointments per year. Case-notes were reviewed up to December 2001.


RESULTS
We treated 386 type 1 patients (59.8% male, mean age 28.7 years, mean duration diabetes 9.5 years). After a mean follow-up of 7.7 years, 261 (67.6%) had attended in the past 2 years, 22 (5.8%) were known to have died, 11 (2.8%) had transferred to another clinic and 92 (23.8%) had repeatedly failed to attend appointments for 2 years. Over 11 years, the total mean (SD) HbA1c was 9.19% (1.3). Only 3.4% of patients achieved an average HbA1c of <7% during the study period, and 80% of patients had average HbA1c levels of >8%.


CONCLUSIONS
Despite regular specialist physician, specialist diabetes nurse and dietician input, encouragement of multiple daily insulin injections and repeatedly following-up failed appointments (including home visits), fewer than 1:20 patients achieved the DCCT target of mean HbA1c <7%. Tight diabetes control is rare in a routine clinic setting.
University Department of Diabetes and Endocrinology, Clinical Sciences Centre, University Hospital Aintree, Liverpool L9 7AL, UK. simon@simple5.freeserve.co.uk
S A
SA
Saunders
M
M
Wallymahmed
I A
IA
MacFarlane
D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D003925:Diabetic Angiopathies / Q000097:blood; D016883:Diabetic Ketoacidosis / Q000175:diagnosis; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D010349:Patient Compliance; D012189:Retrospective Studies; D013997:Time Factors
D006442:Glycated Hemoglobin; D007328:Insulin