S A Saunders1, M Wallymhamed, I A Macfarlane. 1. St. Helens and Knowsley NHS Trust, Whiston Hospital, Warrington Road, Prescot, Merseyside L355DR, UK. saunders-sa@sky.com
Abstract
BACKGROUND: Management of patients with type 1 diabetes in the UK has changed over the past 20 years. The targets for glycaemic control, blood pressure and cholesterol are lower. We examined a cohort of patients with type 1 diabetes who have been through these changes to assess their effects. DESIGN AND METHODS: A cohort of patients with type 1 diabetes who attended a secondary care outpatient diabetes clinic between 1991 and 1996 were reviewed in 2001 and 2006. Comparison is made between current biophysical markers and those obtained in 2001. RESULTS: Only 81.9% (n = 214) of the original cohort attended in 2006. These patients had an average duration of diabetes of 23.46 (SD +/- 8.06) years. There were 134 male patients (62.62%). In these patients HbA1c had reduced by 0.4% (absolute reduction); a relative reduction of 4.41% (P = 0.0001). Statistically significant reductions in diastolic blood pressure (74-68 mmHg) and total cholesterol (5.37-4.62 mmol/l) occurred. However, weight (75.04-82.31 kg) and BMI (25.32-27.72 kg/m(2)) significantly increased. There was no statistically significant change in insulin dose (units/kg), serum creatinine, urinary ACR or systolic blood pressure. CONCLUSION: An urban setting, mobile population and patient non-attendance can complicate modern diabetes care. Despite these difficulties, input by the diabetes team working with the patients can achieve small improvements in Hba1c and cardiovascular risk factors by increased use of long acting insulins, metformin, statins and blood pressure medication.
BACKGROUND: Management of patients with type 1 diabetes in the UK has changed over the past 20 years. The targets for glycaemic control, blood pressure and cholesterol are lower. We examined a cohort of patients with type 1 diabetes who have been through these changes to assess their effects. DESIGN AND METHODS: A cohort of patients with type 1 diabetes who attended a secondary care outpatientdiabetes clinic between 1991 and 1996 were reviewed in 2001 and 2006. Comparison is made between current biophysical markers and those obtained in 2001. RESULTS: Only 81.9% (n = 214) of the original cohort attended in 2006. These patients had an average duration of diabetes of 23.46 (SD +/- 8.06) years. There were 134 male patients (62.62%). In these patients HbA1c had reduced by 0.4% (absolute reduction); a relative reduction of 4.41% (P = 0.0001). Statistically significant reductions in diastolic blood pressure (74-68 mmHg) and total cholesterol (5.37-4.62 mmol/l) occurred. However, weight (75.04-82.31 kg) and BMI (25.32-27.72 kg/m(2)) significantly increased. There was no statistically significant change in insulin dose (units/kg), serum creatinine, urinary ACR or systolic blood pressure. CONCLUSION: An urban setting, mobile population and patient non-attendance can complicate modern diabetes care. Despite these difficulties, input by the diabetes team working with the patients can achieve small improvements in Hba1c and cardiovascular risk factors by increased use of long acting insulins, metformin, statins and blood pressure medication.
Authors: Shona J Livingstone; Helen C Looker; Eleanor J Hothersall; Sarah H Wild; Robert S Lindsay; John Chalmers; Stephen Cleland; Graham P Leese; John McKnight; Andrew D Morris; Donald W M Pearson; Norman R Peden; John R Petrie; Sam Philip; Naveed Sattar; Frank Sullivan; Helen M Colhoun Journal: PLoS Med Date: 2012-10-02 Impact factor: 11.069