title: Achieved levels of HbA1c and likelihood of hospital admission in people with type 1 diabetes in the Scottish population: a study from the Scottish Diabetes Research Network Epidemiology Group.
abstract: OBJECTIVE
  People with type 1 diabetes have increased risk of hospital admission compared with those without diabetes. We hypothesized that HbA(1c) would be an important indicator of risk of hospital admission.
  
  
  METHODS
  The Scottish Care Information-Diabetes Collaboration, a dynamic national register of diagnosed cases of diabetes in Scotland, was linked to national data on admissions. We identified 24,750 people with type 1 diabetes during January 2005 to December 2007. We assessed the relationship between deciles of mean HbA(1c) and hospital admissions in people with type 1 diabetes adjusting for patient characteristics.
  
  
  RESULTS
  There were 3,229 hospital admissions. Of the admissions, 8.1% of people had mean HbA(1c) <7.0% (53 mmol/mol) and 16.3% had HbA(1c) <7.5% (58 mmol/mol). The lowest odds of admission were associated with HbA(1c) 7.7-8.7% (61-72 mmol/mol). When compared with this decile, a J-shaped relationship existed between HbA(1c) and admission. The highest HbA(1c) decile (10.8-18.4%/95-178 mmol/mol) showed significantly higher odds ratio (95% CI) for any admission (2.80, 2.51-3.12); the lowest HbA(1c) decile (4.4-7.1%/25-54 mmol/mol) showed an increase in odds of admission of 1.29 (1.10-1.51). The highest HbA(1c) decile experienced significantly higher odds of diabetes-related (3.31, 2.94-3.72) and diabetes ketoacidosis admissions (10.18, 7.96-13.01).
  
  
  CONCLUSIONS
  People with type 1 diabetes with highest and lowest mean HbA(1c) values were associated with increased odds of admission. People with high HbA(1c) (>10.8%/95 mmol/mol) were at particularly high risk. There is the need to develop effective interventions to reduce this risk.
authors.affiliation: Centre for Population and Health Sciences, University of Glasgow, Glasgow, UK. lindsay.govan@glasgow.ac.uk
authors.forename: Lindsay
authors.initials: L
authors.lastname: Govan
authors.forename: Olivia
authors.initials: O
authors.lastname: Wu
authors.forename: Andrew
authors.initials: A
authors.lastname: Briggs
authors.forename: Helen M
authors.initials: HM
authors.lastname: Colhoun
authors.forename: Colin M
authors.initials: CM
authors.lastname: Fischbacher
authors.forename: Graham P
authors.initials: GP
authors.lastname: Leese
authors.forename: John A
authors.initials: JA
authors.lastname: McKnight
authors.forename: Sam
authors.initials: S
authors.lastname: Philip
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Wild
authors.forename: Robert S
authors.initials: RS
authors.lastname: Lindsay
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000378:metabolism*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012606:Scotland / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin