Background: Poor glycaemic control, indicated by a high HbA1c level, increases the risk of developing complications of type 1 diabetes. It is, therefore important to reduce HbA1c levels aiming for the new target outlined by NICE (2015) of 48 mmol/mol. To try and improve HbA1c levels in patients attending a large urban diabetic clinic a policy was developed, targeting patients with an HbA1c level of 64 mmol/mol or higher.
Objective and hypotheses: To assess whether the policy was implemented correctly and if it was effective in reducing HbA1c levels.
Method: A computer database search was made of patients with a latest HbA1c of >57 mmol/mol. Patients without type 1 diabetes or diagnosed within 1 year, those with a first high HbA1c within 6 months and those who had not had a high HbA1c over the past year were excluded. The database was reviewed over 1 year, recording HbA1c levels, appointments, telephone calls and hospital admissions.
Results: 138 patients were identified but 39 excluded, leaving 99 patients. Average initial HbA1c was 76 mmol/mol. 72.7% were offered 100% of appointments as recommended. Patients with initial HbA1c of >86 mmol/mol were most likely to have a lower Hba1c after 1 year (76% vs 50% of HbA1c of 6475 mmol/mol) but were more likely to not attend appointments (2.76 missed appointments/patient/year vs 1.79). Of the patients with HbA1c of 6475 mmol/mol those who had no telephone calls had a smaller increase in HbA1c than average (0.46 vs 1.23) and those with 100% attendance had an average decrease in HbA1c of 0.69. Elective hospital admission led to reduction in HbA1c at 3 months (97.582.25 mmol/mol) but an increase to 95.14 at 6 months.
Conclusion: 100% clinic attendance is linked to lower HbA1c, hospital admission reduces HbA1c in the short term only, but telephone calls did not lead to lower HbA1c.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology