Glycaemic control and lipid concentrations in a cohort of people with diabetes over 7 years of follow‐up: a regional audit of diabetes care in the UK. Issue 3 (18th August 2015)

• Record Type: Journal Article
• Authors: Wainwright, P.; Oluwatowoju, I.; Ryan, A.; Abu, E.; Byrne, C. D.
• Is Part Of: Diabetic medicine. Volume 33:Issue 3(2016:Mar.)
• Page Start: 386
• Page End: 390
• Publication Date: 2015-08-18
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.12853
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aim: To determine changes in glycaemic control and lipids over time since the introduction of the Quality and Outcomes Framework. Methods: In adults with diabetes (Hampshire, UK), HbA1c and lipid measurements were retrieved from a regional National Health Service biochemical database in 2006 and 2013 and analysed using anova and logistic regression modelling. Results: In 2006, 8568 people with diabetes were identified. In 2013, 5815 had follow‐up data, 1207 people were lost to follow‐up and 1546 had died. At baseline, HbA1c concentrations were 62.1 ± 16.1, 64.7 ± 16.7 and 64.5 ± 17.6 mmol/mol for those with follow‐up data, those lost to follow‐up and those who died, respectively. The mean age was 60.2 ± 14.5, 57.6 ± 18.0 and 73.9 ± 10.5 years, respectively, for the three groups. Total cholesterol, HDL cholesterol and triglyceride concentrations were similar between groups. The mean HbA1c concentration for those with complete follow‐up data was 62.1 ± 16.1 mmol/mol in 2006 and 61.7 ± 17.3 mmol/mol in 2013. Quality and Outcomes Framework targets for cholesterol (< 5 mmol/l) were achieved by 79% of people in 2006 and 83% in 2013 ( P < 0.001). Baseline age and HbA1c were associated with death at follow‐up: the odds ratio per year increase in baseline age was 1.10 (95% CI 1.09–1.10; P < 0.001) and per unit increase in HbA1c it was 1.02 (95% CI 1.02–1.03; P < 0.001). Conclusions: Glycaemic control showed remarkable stability over 7 years of follow‐up, despite increasing patient age and duration of diabetes. More patients achieved lipid targets in 2013 than in 2006. Although baseline HbA1c was a predictor of death at follow‐up, baseline HbA1c differed little between survivors, non‐survivors and those lost to follow‐up. What's new?: This is the first report of a longitudinal audit of the attainment of glycaemic and lipid targets in a large cohort of individuals with diabetes, followed for 7 years, after the introduction of the Quality and Outcomes Framework targets in the UK. The audit shows surprising maintenance of glycaemic control throughout the 7‐year period of the audit with a mean HbA1c concentration of 62.1 ± 16.1 mmol/mol in 2006, compared with 61.7 ± 17.3 mmol/mol in 2013. There was improvement in the proportion of people achieving target total cholesterol of < 5 mmol/l, from 79% in 2006 to 83% in 2013.