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- Lilja, Mikael, et al.
(författare)
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Determinants of HbA1c in patients with type 1 diabetes in seven Swedish county councils
- 2015
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Ingår i: Diabetologia. - : Springer. - 0012-186X .- 1432-0428. ; 58:Suppl. 1 Abstr. 278, s. S140-S141
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background and aims: In order to make fair comparisons between the results of different health care providers, proper consideration of the casemix of the populations they serve is important. HbA1c is often used as a metric to indicate the quality of diabetes care, it is therefore of value to determine what patient characteristics affect this outcome. As part of the ongoing National Collaboration for Value Based Reimbursement and Monitoring Systems, we therefore set out to investigate what factors are associated with HbA1c in a large retrospective cohort of persons with type 1 diabetes.Materials and methods: This was a retrospective register study where we analyzed persons 18 years or older, with a health care contact and a diagnosis of diabetes during 2010-11 in the administrative systems of seven Swedish county councils (Dalarna, Jämtland Härjedalen, Skåne, Stockholm, Uppsala, Västra Götaland and Östergötland), covering ~70% of the Swedish population and linked this data to data from the National Diabetes Register, socioeconomic data from Statistics Sweden and data on filled prescriptions from the Prescribed Drug Register. We estimated a random effect model on HbA1c after one year of follow-up, including socioeconomic, demographic and clinical factors.Results: Based on a complete case approach, 13 396 patients were analyzed. Women had on average higher HbA1c than men. Blood sugar control seemed to be better with higher age. Of the socioeconomic factors, higher education was associated with lower levels of HbA1c, as was being married. By contrast, we found no association between HbA1c and being born outside the EU.Ahistory (previous 2 years) of diabetes related complications were associated with higher levels of HbA1c, which is likely due to high levels of HbA1c being an indicator of what is causing the complications in the first place. The exception to this pattern was patients with renal failure.Conclusion: Apart from obvious demographic factors such as age and gender as well as disease history, educational and civil status are important factors to take into consideration when comparing obtained HbA1c levels between health care providers. This also raises the question of the need for additional focus on education directed towards these groups to facilitate improved diabetes management.
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