Predictors of Glycaemic Control in Type 1 Diabetic Patients after Participation in an Intensified Treatment and Teaching Programme

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Abstract
The aim of the study was to identify predictors of long‐term glycaemic control in Type 1 diabetic patients after participation in an intensified insulin treatment and teaching programme. The study population consisted of 697 Type 1 diabetic patients (mean age 26 ± 7 (SD) years, duration of diabetes 8 ± 7 years) who participated in the same structured intensified insulin treatment and teaching programme in 10 hospitals and who were re‐examined after 1, 2, and 3 years. Multiple and logistic regression analyses were performed including a set of demographic, disease‐related, social, and psychosocial variables as potential predictors. As dependent variables the average HbA1 values during the 3‐year follow‐up period and a composite variable (average HbA1 values/frequency of severe hypoglycaemia)—dividing patients into three groups with good, moderate or poor metabolic control—were considered. Regression analysis of average HbA1 values revealed significance (p R2 (percentage of variation explained by the model) = 17%). In a second regression model, HbA1 values before the intervention programme were added to the model and achieved the highest standardized regression coefficient (0.38), increasing R2 to 29%. In the logistic regression models considering both HbA1 and severe hypoglycaemia as a composite dependent variable, diabetes‐related knowledge, HbA1 values before the intervention, smoking, perceived coping abilities, age at onset of diabetes, and C‐peptide levels were the strongest predictors of glycaemic control. In conclusion, the relationship between demographic, disease‐related, psychosocial, and social variables and metabolic control is complex. Therefore, simplistic concepts of linear causality should be abandoned. In addition to HbA1 values before the intervention, smoking, diabetes‐related knowledge, home blood glucose monitoring, age at onset of diabetes, perceived coping abilities and C‐peptide levels were the most significant and consistent predictors of glycaemic control.