Factors Influencing Glycemic Control in Young People With Type 1 Diabetes in Scotland

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Abstract
OBJECTIVE— To evaluate differences in HbAlcconcentrations between centers and to assess the factors associated with glycemic control in young people with type 1 diabetes in Scotland. RESEARCH DESIGN AND METHODS— Data on 1,755 patients (94% of those registered) were collected from 18 centers providing care to children<15 years of age. At every clinic visit, a duplicate HbAlcsample was measured in a reference laboratory, and clinical information was collected prospectively. RESULTS— Average HbAlc concentration was 9.1%(range 5.0-15.0). The following significant associations with HbAlclevel were identified: age, insulin regimen, BMI, season, social circumstances, and family history. HbAlc concentrations were significantly worse in older children (age 10-15 years 9.5% vs. other ages 8.8%, P < 0.001), those using two injections per day (2/day 9.1%vs. 3/day 8.8%, P < 0.01), children without both parents at home(9.4 vs. 9.0%, P < 0.001), a sibling with diabetes (9.7% vs. no family history 9.1%, P < 0.001). HbAlc concentration ranged from 8.1 to 10.2% between centers, after adjustment for factors associated with poor HbAlc (P < 0.001). CONCLUSIONS— The overall glycemic control of diabetic young people in Scotland is equivalent to a Diabetes Control and Complications Trial HbAlc concentration of 8.7%, placing the majority at a high risk of the complications of diabetes in adulthood. Although factors were significantly associated with poor HbAlc, adjustment for these did not explain the differences between centers. We suggest that factors not analyzed in DIABAUD2 (e.g., deployment of resources, organization of the clinical structure, strategies of care, and clinic philosophy) are the determinants of HbAlc. We speculate that the style of utilization of optimum resources is the key to achieving good glycemic control.