Route to improving Type 1 diabetes mellitus glycaemic outcomes: real-world evidence taken from the National Diabetes Audit.

Autor: Heald AH; School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.; Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK., Livingston M; Department of Blood Sciences, Walsall Manor Hospital, Walsall, UK., Fryer A; Institute for Applied Clinical Sciences, Keele University, Keele, UK., Moreno GYC; Co-ordinator of the Obesity Clinic in the Medicine School of Instituto Politécnico Nacional, Mexico City, Mexico., Malipatil N; School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK., Gadsby R; Warwick Medical School, University of Warwick, Coventry, UK., Ollier W; School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK., Lunt M; School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK., Stedman M; RES Consortium, Andover, Wiltshire, UK., Young RJ; National Diabetes Audit, Central Office Diabetes UK, London, UK.
Jazyk: angličtina
Zdroj: Diabetic medicine : a journal of the British Diabetic Association [Diabet Med] 2018 Jan; Vol. 35 (1), pp. 63-71.
DOI: 10.1111/dme.13541
Abstrakt: Aim: To use general practice-level data for England, available through the National Diabetes Audit, and primary care prescribing data to identify prescription treatment factors associated with variations in achieved glucose control (HbA 1c ).
Methods: General practice-level National Diabetes Audit data on Type 1 diabetes, including details of population characteristics, services, proportion of people achieving target glycaemic control [HbA 1c ≤58 mmol/mol (7.5%)] and proportion of people at high glycaemic risk [HbA 1c >86 mmol/ml (10%)], were linked to 2013-2016 primary care diabetes prescribing data on insulin types and blood glucose monitoring for all people with diabetes.
Results: A wide variation was found between the 10 th percentile and the 90 th percentile of general practices in both target glycaemic control (15.6% to 44.8%, respectively) and high glycaemic risk (4.8% to 28.6%, respectively). Our analysis suggests that, given the extrapolated total of 280 000 people with Type 1 diabetes in the UK, there may be the potential to increase the number of those within target glycaemic control from 80 000 to 101 000; 53% of this increase (11 000 people) would result from service improvements and 47% (10 000 people) from medication and technology changes. The same improvements would also provide the opportunity to reduce the number of people at high glycaemic risk from 42 000 to 26 500. A key factor associated with practice-level target HbA 1c achievement would be greater use of insulin pumps for up to an additional 56 000 people.
Conclusion: If the HbA 1c achievement rates in service provision, medication and use of technology currently seen in practices in the 90 th percentile were to be matched with regard to HbA 1c achievement rates in all general practices, glycaemic control might be improved for 36 500 people, with all the attendant health benefits.
(© 2017 Diabetes UK.)
Databáze: MEDLINE
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