Genom data från det norska diabetesregistret och den norska statistiska sentralbyrån har forskarna samlat uppgifter om 7 602 personer med typ 1-diabetes. Bakgrunden var att man ville hitta möjliga förklaringar till varför omkring 22 procent av vuxna typ 1-diabetiker i Norge har ett långtidsblodsocker, HbA1c, på 75 mmol/mol eller högre, skriver Petra Hedbom www.dagensmedicin.se
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Materials and methods: 7602 participants over 18 years of age with a diabetes duration of more than two years who had an HbA1c recorded in the NDV between 1st January 2013 and 31st December 2015 were included in the study. The primary outcome of the study was poor glycaemic control defined as HbA1c ≥ 9%. Variables potentially associated with glycaemic control were investigated using univariable and multivariable regression analyses adjusted for clustering of observations within hospital diabetes clinics. Odds ratio for HbA1c ≥ 9% and 95% confidence intervals are reported. In view of the large sample size and the number of variables evaluated p < 0.01 was chosen as the level of statistical significance. Statistical analyses were performed in Stata 14.0.
Results: The average age of the 7602 participants was 43 years, average duration of diabetes was 22 years and 46.8% were female. The overall mean HbA1c level was 8.0% and 18.7% had an HbA1c ≥ 9%. Multivariable regression analysis showed that age between 18 - 25 years and current smoking were significantly associated with an increased risk of having an HbA1c ≥ 9%, whereas higher level of education, increasing numbers of glucose measurements and exercise more than three days a week were significantly associated with attenuated risk. In addition several variables from the univariable analysis (not included in the multivariable regression analysis due to feedback issues) were significantly associated with poor glycaemic control. For example insulin pump therapy and higher daily insulin dose per kg were associated with increased risk of HbA1c ≥ 9%, whereas increasing numbers of hypoglycaemic episodes per month was associated with attenuated risk of HbA1c ≥ 9%.
Resultaten, som presenteras på EASD i Lissabon, visar en koppling mellan blodsockerkontroll och ett flertal socioekonomiska faktorer. Bland personer mellan 18 och 25 år var fanns en tydlig koppling mellan rökning och en ökad risk för ett för högt blodsockervärde.
Personer med en högre utbildning och de som ägnade sig åt fysisk aktivitet minst tre gånger i veckan hade ett mer välkontrollerat blodsocker. Även tätare mätning av blodsockret kunde också kopplas till en låg risk för högt blodsocker.
Medelåldern av personerna i studien var 43 år och de hade i genomsnitt haft diabetes i 22 år. Totala medelvärden av HbA1c nivåer var 64 mmol/mol och omkring en fjärdedel hade HbA1c på 74 mmol/mol eller mer.
Eftersom ett högt långtidsblodsocker innebär en ökad risk för bland annat hjärt-kärlsjukdom menar forskarna bakom studien att det är viktigt att skapa medvetenhet kring vilka faktorer som kan påverka patienterna att till sämre blodsockerkontroll. Genom det kan patienterna ges individuellt stöd för att komma tillrätta med sina värden, vilket i sin tur är viktigt för att undvika komplikationer.
Abstract
AuthorsJ.G. Cooper1, G. Thue2, I. Dalen3, S. Carlsen1, Å. Bakke1, K. Løvaas2, S. Sandberg2;
1Department of Medicine, Stavanger University Hospital, Stavanger, Norway, 2Norwegian Quality Improvement of Laboratory Examinations (Noklus), Bergen, Norway, 3Research Department, Stavanger University Hospital, Stavanger, Norway.
1Department of Medicine, Stavanger University Hospital, Stavanger, Norway, 2Norwegian Quality Improvement of Laboratory Examinations (Noklus), Bergen, Norway, 3Research Department, Stavanger University Hospital, Stavanger, Norway.
Background and aims: Randomized studies in patients with type 1 diabetes have shown that improved blood glucose control significantly reduces the risk of developing microvascular complications. Observational studies have demonstrated a substantial increase in the risk of death with higher HbA1c levels. A registry based study from Norway has shown that 22% of adult patients with type 1 diabetes had an HbA1c ≥ 9% in 2012. The aim of this study is to assess factors associated with poor glycaemic control using variables registered in the Norwegian Diabetes Registry for Adults (NDV) between 2013 - 2015, together with socioeconomic data obtained from Statistics Norway in 2015.
Materials and methods: 7602 participants over 18 years of age with a diabetes duration of more than two years who had an HbA1c recorded in the NDV between 1st January 2013 and 31st December 2015 were included in the study. The primary outcome of the study was poor glycaemic control defined as HbA1c ≥ 9%. Variables potentially associated with glycaemic control were investigated using univariable and multivariable regression analyses adjusted for clustering of observations within hospital diabetes clinics. Odds ratio for HbA1c ≥ 9% and 95% confidence intervals are reported. In view of the large sample size and the number of variables evaluated p < 0.01 was chosen as the level of statistical significance. Statistical analyses were performed in Stata 14.0.
Results: The average age of the 7602 participants was 43 years, average duration of diabetes was 22 years and 46.8% were female. The overall mean HbA1c level was 8.0% and 18.7% had an HbA1c ≥ 9%. Multivariable regression analysis showed that age between 18 - 25 years and current smoking were significantly associated with an increased risk of having an HbA1c ≥ 9%, whereas higher level of education, increasing numbers of glucose measurements and exercise more than three days a week were significantly associated with attenuated risk. In addition several variables from the univariable analysis (not included in the multivariable regression analysis due to feedback issues) were significantly associated with poor glycaemic control. For example insulin pump therapy and higher daily insulin dose per kg were associated with increased risk of HbA1c ≥ 9%, whereas increasing numbers of hypoglycaemic episodes per month was associated with attenuated risk of HbA1c ≥ 9%.
Conclusion: This study has provided representative national data that demonstrate a strong association between blood glucose control and several patient and socioeconomic factors. A better awareness and understanding of these factors could lead to more individualized management strategies, better glycemic control and a lower risk of diabetes complications.
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