Effect of an Integrated, Multidisciplinary Nationwide Approach to Type 1 Diabetes Care on Metabolic Outcomes: An Observational Real-World Study

• Main Authors: Casteels, K. (Author), Chao, S. (Author), De Block, C. (Author), Doggen, K. (Author), Lavens, A. (Author), Mathieu, C. (Author), Mouraux, T. (Author), Nobels, F. (Author), Oriot, P. (Author), Verhaegen, A. (Author)
• Format: Article
• Language: English
• Published: Mary Ann Liebert Inc. 2021
• Subjects: adolescent; Adolescent; adult; Adult; aged; Aged; Aged, 80 and over; antihypertensive agent; antilipemic agent; Article; Belgium; Blood Glucose; blood glucose monitoring; Blood Glucose Self-Monitoring; child; Child; Child, Preschool; collaborative care team; continuous infusion; controlled study; cross-sectional study; Diabetes care; diabetes control; diabetes education; Diabetes education; Diabetes Mellitus, Type 1; female; glucose blood level; Glycated Hemoglobin A; glycosylated hemoglobin; HbA1c; hemoglobin A1c; human; Humans; infant; Infant; insulin; Insulin; insulin dependent diabetes mellitus; insulin infusion; Insulin Infusion Systems; low density lipoprotein cholesterol; major clinical study; male; metabolic regulation; middle aged; Middle Aged; multicenter study; patient care; preschool child; Quality assurance program; retrospective study; systolic blood pressure; Type 1 diabetes; very elderly; young adult; Young Adult
• Online Access: View Fulltext in Publisher

 Objective: Achieving good metabolic control in people with type 1 diabetes (T1D) remains a challenge, despite the evolutions in diabetes technologies over the past decade. Here we investigate the evolution of metabolic control in people with T1D, where care is provided by specialized centers with access to technology, diabetes education, and regular follow-up. Methods: Data were cross-sectionally collected between 2010 and 2018 from more than 100 centers in Belgium. The evolutions over time of hemoglobin A1C (HbA1c), low-density lipoprotein (LDL) cholesterol, and systolic blood pressure (SBP) were investigated, together with the evolutions of use of insulin pump (continuous subcutaneous insulin infusion [CSII]), continuous glucose monitoring (CGM), and lipid-lowering and antihypertensive drugs. Association of HbA1c with gender, age, diabetes duration, and technology use was analyzed on the most recent cohort. Results: The study population contained data from 89,834 people with T1D (age 1-80 years). Mean HbA1c decreased from 65 mmol/mol (8.1%) in 2010-2011 to 61 mmol/mol (7.7%) in 2017-2018 (P < 0.0001, adjusted for gender, age, diabetes duration, and technology use). Respectively, mean LDL cholesterol decreased from 2.45 mmol/L (94.6 mg/dL) to 2.29 mmol/L (88.5 mg/dL) (P < 0.0001, adjusted for gender, age, and diabetes duration), and mean SBP remained stable. CGM usage increased, whereas the use of CSII and lipid-lowering and antihypertensive drugs remained stable. Gender, age, diabetes duration, and technology use were independently associated with HbA1c. Conclusions: Our real-world data show that metabolic and lipid control improved over time in a system where T1D care is organized through specialized multidisciplinary centers with emphasis on linking education to provision of technology, and its quality is monitored. © 2021, Mary Ann Liebert, Inc., publishers.