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QJM 2004 97(9):575-580; doi:10.1093/qjmed/hch098
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QJM vol. 97 no. 9 © Association of Physicians 2004; all rights reserved.

Glycaemic control in a type 1 diabetes clinic for younger adults

S.A. Saunders, M. Wallymahmed and I.A. MacFarlane

From the University Department of Diabetes and Endocrinology, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK

Received 19 February 2004 and in revised form 12 May 2004

Background: In the Diabetes Control and Complications Trial (DCCT, 1993) tight diabetes control (HbA1c <7%) was associated with significantly less microvascular complications compared to ‘conventionally’ treated type 1 patients.

Aim: To assess the effectiveness of a dedicated young-adult type 1 diabetes clinic in achieving HbA1c levels <7% between 1991 and 2001.

Design: Retrospective review of case-notes.

Methods: All patients who attended the clinic in the first six years (1991 to 1996) were studied. All were offered at least two appointments per year. Case-notes were reviewed up to December 2001.

Results: We treated 386 type 1 patients (59.8% male, mean age 28.7 years, mean duration diabetes 9.5 years). After a mean follow-up of 7.7 years, 261 (67.6%) had attended in the past 2 years, 22 (5.8%) were known to have died, 11 (2.8%) had transferred to another clinic and 92 (23.8%) had repeatedly failed to attend appointments for 2 years. Over 11 years, the total mean (SD) HbA1c was 9.19% (1.3). Only 3.4% of patients achieved an average HbA1c of <7% during the study period, and 80% of patients had average HbA1c levels of >8%.

Discussion: Despite regular specialist physician, specialist diabetes nurse and dietician input, encouragement of multiple daily insulin injections and repeatedly following-up failed appointments (including home visits), fewer than 1:20 patients achieved the DCCT target of mean HbA1c <7%. Tight diabetes control is rare in a routine clinic setting.

Address correspondence to Dr S.A. Saunders, University Department of Diabetes and Endocrinology, Clinical Sciences Centre, University Hospital Aintree, Liverpool L9 7AL. e-mail: simon{at}simple5.freeserve.co.uk


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