title: Glycaemic control and lipid concentrations in a cohort of people with diabetes over 7 years of follow-up: a regional audit of diabetes care in the UK.
abstract: OBJECTIVE
  To determine changes in glycaemic control and lipids over time since the introduction of the Quality and Outcomes Framework.
  
  
  METHODS
  In adults with diabetes (Hampshire, UK), HbA1c and lipid measurements were retrieved from a regional National Health Service biochemical database in 2006 and 2013 and analysed using anova and logistic regression modelling.
  
  
  RESULTS
  In 2006, 8568 people with diabetes were identified. In 2013, 5815 had follow-up data, 1207 people were lost to follow-up and 1546 had died. At baseline, HbA1c concentrations were 62.1 ± 16.1, 64.7 ± 16.7 and 64.5 ± 17.6 mmol/mol for those with follow-up data, those lost to follow-up and those who died, respectively. The mean age was 60.2 ± 14.5, 57.6 ± 18.0 and 73.9 ± 10.5 years, respectively, for the three groups. Total cholesterol, HDL cholesterol and triglyceride concentrations were similar between groups. The mean HbA1c concentration for those with complete follow-up data was 62.1 ± 16.1 mmol/mol in 2006 and 61.7 ± 17.3 mmol/mol in 2013. Quality and Outcomes Framework targets for cholesterol (< 5 mmol/l) were achieved by 79% of people in 2006 and 83% in 2013 (P < 0.001). Baseline age and HbA1c were associated with death at follow-up: the odds ratio per year increase in baseline age was 1.10 (95% CI 1.09-1.10; P < 0.001) and per unit increase in HbA1c it was 1.02 (95% CI 1.02-1.03; P < 0.001).
  
  
  CONCLUSIONS
  Glycaemic control showed remarkable stability over 7 years of follow-up, despite increasing patient age and duration of diabetes. More patients achieved lipid targets in 2013 than in 2006. Although baseline HbA1c was a predictor of death at follow-up, baseline HbA1c differed little between survivors, non-survivors and those lost to follow-up.
authors.affiliation: Clinical Biochemistry, University Hospital Southampton, Southampton, UK.
authors.forename: P
authors.initials: P
authors.lastname: Wainwright
authors.affiliation: Clinical Biochemistry, University Hospital Southampton, Southampton, UK.
authors.forename: I
authors.initials: I
authors.lastname: Oluwatowoju
authors.affiliation: Clinical Biochemistry, University Hospital Southampton, Southampton, UK.
authors.forename: A
authors.initials: A
authors.lastname: Ryan
authors.affiliation: Clinical Biochemistry, University Hospital Southampton, Southampton, UK.
authors.forename: E
authors.initials: E
authors.lastname: Abu
authors.affiliation: Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK.|Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, Southampton, UK.
authors.forename: C D
authors.initials: CD
authors.lastname: Byrne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008055:Lipids / Q000097:blood*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D008055:Lipids