QJM Advance Access originally published online on October 1, 2008
QJM 2009 102(1):29-34; doi:10.1093/qjmed/hcn125
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Improvements in glycaemic control and cardiovascular risk factors in a cohort of patients with type 1 diabetes over a 5-year period
From the 1St Helens and Knowsley NHS Trust and 2University Hospitals Aintree Foundation NHS Trust
Address correspondence to Dr Simon Saunders, MB.Ch.B. (Hons), B.Sc. (Hons), St Helens and Knowsley NHS Trust, Whiston Hospital, Warrington Road, Prescot, Merseyside L35 5DR, UK. email: saunders-sa{at}sky.com
Received 26 May 2008 and in revised form 3 September 2008
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Abstract |
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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 2001and 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/m2) significantly increased. There was no statistically significant change in insulin dose (units/kg), serum creatinine, urinary ACR or systolic blood pressure.
Conclusions: 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 acing insulins, metformin, statins and blood pressure medication.