K A McBrien1,2,3, B J Manns4,5,6,7, B R Hemmelgarn4,5,6,7, R Weaver6, A L Edwards6,8, N Ivers9,10, D Rabi5,6, R Lewanczuk11,12, T Braun13,14, C Naugler13,15,16, D Campbell4,6, N Saad6, M Tonelli6. 1. Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada. kamcbrie@ucalgary.ca. 2. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada. kamcbrie@ucalgary.ca. 3. O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada. kamcbrie@ucalgary.ca. 4. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada. 5. O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada. 6. Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada. 7. Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada. 8. Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Toronto, Canada. 9. Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada. 10. Women's College Hospital, Toronto, Canada. 11. Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. 12. Provincial Primary Health Care, Alberta Health Services, Calgary, Canada. 13. Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada. 14. Calgary Zone, Alberta Health Services, Calgary, Canada. 15. Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada. 16. Calgary Laboratory Services, Calgary, Canada.
Abstract
AIMS: People with diabetes and poor glycaemic control are at higher risk of diabetes-related complications and incur higher healthcare costs. An understanding of the sociodemographic and clinical characteristics associated with poor glycaemic control is needed to overcome the barriers to achieving care goals in this population. METHODS: We used linked administrative and laboratory data to create a provincial cohort of adults with prevalent diabetes, and a measure of HbA1c that occurred at least 1 year following the date of diagnosis. The primary outcome was poor glycaemic control, defined as at least two consecutive HbA1c measurements ≥ 86 mmol/mol (10%), not including the index measurement, spanning a minimum of 90 days. We used multivariable Cox proportional hazards models to evaluate the association between baseline sociodemographic and clinical factors and poor glycaemic control. RESULTS: In this population-based cohort of 169 890 people, younger age was significantly associated with sustained poor glycaemic control, with a hazard ratio (HR) of 3.08, 95% CI (2.79-3.39) for age 18-39 years compared with age ≥ 75 years. Longer duration of diabetes, First Nations status, lower neighbourhood income quintile, history of substance abuse, mood disorder, cardiovascular disease, albuminuria and high LDL cholesterol were also associated with poor glycaemic control. CONCLUSIONS: Although our results may be limited by the observational nature of the study, the large geographically defined sample size, longitudinal design and robust definition of poor glycaemic control are important strengths. These findings demonstrate the complexity associated with poor glycaemic control and indicate a need for tailored interventions.
AIMS: People with diabetes and poor glycaemic control are at higher risk of diabetes-related complications and incur higher healthcare costs. An understanding of the sociodemographic and clinical characteristics associated with poor glycaemic control is needed to overcome the barriers to achieving care goals in this population. METHODS: We used linked administrative and laboratory data to create a provincial cohort of adults with prevalent diabetes, and a measure of HbA1c that occurred at least 1 year following the date of diagnosis. The primary outcome was poor glycaemic control, defined as at least two consecutive HbA1c measurements ≥ 86 mmol/mol (10%), not including the index measurement, spanning a minimum of 90 days. We used multivariable Cox proportional hazards models to evaluate the association between baseline sociodemographic and clinical factors and poor glycaemic control. RESULTS: In this population-based cohort of 169 890 people, younger age was significantly associated with sustained poor glycaemic control, with a hazard ratio (HR) of 3.08, 95% CI (2.79-3.39) for age 18-39 years compared with age ≥ 75 years. Longer duration of diabetes, First Nations status, lower neighbourhood income quintile, history of substance abuse, mood disorder, cardiovascular disease, albuminuria and high LDL cholesterol were also associated with poor glycaemic control. CONCLUSIONS: Although our results may be limited by the observational nature of the study, the large geographically defined sample size, longitudinal design and robust definition of poor glycaemic control are important strengths. These findings demonstrate the complexity associated with poor glycaemic control and indicate a need for tailored interventions.
Authors: Lili Huo; Wei Deng; Jonathan E Shaw; Dianna J Magliano; Puhong Zhang; Helen C McGuire; Katarzyna Kissimova-Skarbek; David Whiting; Linong Ji Journal: J Diabetes Investig Date: 2020-05-30 Impact factor: 4.232
Authors: Dana Lee Olstad; Reed Beall; Eldon Spackman; Sharlette Dunn; Lorraine L Lipscombe; Kienan Williams; Richard Oster; Sara Scott; Gabrielle L Zimmermann; Kerry A McBrien; Kieran J D Steer; Catherine B Chan; Sheila Tyminski; Seth Berkowitz; Alun L Edwards; Terry Saunders-Smith; Saania Tariq; Naomi Popeski; Laura White; Tyler Williamson; Mary L'Abbé; Kim D Raine; Sara Nejatinamini; Aruba Naser; Carlota Basualdo-Hammond; Colleen Norris; Petra O'Connell; Judy Seidel; Richard Lewanczuk; Jason Cabaj; David J T Campbell Journal: BMJ Open Date: 2022-02-15 Impact factor: 2.692
Authors: Marília B Gomes; Fengming Tang; Hungta Chen; Javier Cid-Ruzafa; Peter Fenici; Kamlesh Khunti; Wolfgang Rathmann; Marina V Shestakova; Filip Surmont; Hirotaka Watada; Jesús Medina; Iichiro Shimomura; Gabriela Luporini Saraiva; Andrew Cooper; Antonio Nicolucci Journal: Front Endocrinol (Lausanne) Date: 2022-04-22 Impact factor: 6.055