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. 2011 Sep;34(9):1992-7.
doi: 10.2337/dc10-2099. Epub 2011 Jul 25.

Achieved levels of HbA1c and likelihood of hospital admission in people with type 1 diabetes in the Scottish population: a study from the Scottish Diabetes Research Network Epidemiology Group

Lindsay Govan  1 , Olivia Wu, Andrew Briggs, Helen M Colhoun, Colin M Fischbacher, Graham P Leese, John A McKnight, Sam Philip, Naveed Sattar, Sarah H Wild, Robert S Lindsay; Scottish Diabetes Research Network Epidemiology Group
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Achieved levels of HbA1c and likelihood of hospital admission in people with type 1 diabetes in the Scottish population: a study from the Scottish Diabetes Research Network Epidemiology Group

Lindsay Govan et al. Diabetes Care. 2011 Sep.

Abstract

Objective: People with type 1 diabetes have increased risk of hospital admission compared with those without diabetes. We hypothesized that HbA(1c) would be an important indicator of risk of hospital admission.

Research design and methods: The Scottish Care Information-Diabetes Collaboration, a dynamic national register of diagnosed cases of diabetes in Scotland, was linked to national data on admissions. We identified 24,750 people with type 1 diabetes during January 2005 to December 2007. We assessed the relationship between deciles of mean HbA(1c) and hospital admissions in people with type 1 diabetes adjusting for patient characteristics.

Results: There were 3,229 hospital admissions. Of the admissions, 8.1% of people had mean HbA(1c) <7.0% (53 mmol/mol) and 16.3% had HbA(1c) <7.5% (58 mmol/mol). The lowest odds of admission were associated with HbA(1c) 7.7-8.7% (61-72 mmol/mol). When compared with this decile, a J-shaped relationship existed between HbA(1c) and admission. The highest HbA(1c) decile (10.8-18.4%/95-178 mmol/mol) showed significantly higher odds ratio (95% CI) for any admission (2.80, 2.51-3.12); the lowest HbA(1c) decile (4.4-7.1%/25-54 mmol/mol) showed an increase in odds of admission of 1.29 (1.10-1.51). The highest HbA(1c) decile experienced significantly higher odds of diabetes-related (3.31, 2.94-3.72) and diabetes ketoacidosis admissions (10.18, 7.96-13.01).

Conclusions: People with type 1 diabetes with highest and lowest mean HbA(1c) values were associated with increased odds of admission. People with high HbA(1c) (>10.8%/95 mmol/mol) were at particularly high risk. There is the need to develop effective interventions to reduce this risk.

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Figures

Figure 1
Figure 1
Adjusted OR (and 95% CI) of types of admission to hospital (reference decile = 3) by HbA1c decile: all-cause excluding hypoglycemia and cancer (A) and all-cause excluding diabetes related (B). Dashed vertical lines represent the HbA1c range of each decile. (A high-quality color representation of this figure is available in the online issue.)
See this image and copyright information in PMC

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