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Intra-individual variability and longitudinal changes in glycaemic control in patients with Type 1 diabetes mellitus
1Department of Internal Medicine, University Hospital of Tromsø, Norway. medrj@rito.no
Insights
Glycemic control in Type 1 diabetes mellitus (DM) is stable, with HbA1c levels showing minimal variation over time. Early HbA1c measurements after starting insulin predict future glycemic control in patients with Type 1 DM.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Diabetes Research
Background:
- Type 1 diabetes mellitus (DM) management aims for stable glycemic control.
- Intra-individual HbA1c variability is a key metric for assessing long-term diabetes management.
- Understanding predictors of HbA1c stability is crucial for optimizing patient outcomes.
Purpose of the Study:
- To investigate predictors of intra-individual HbA1c variability in Type 1 DM patients.
- To analyze changes in HbA1c levels over time in relation to treatment and patient characteristics.
Main Methods:
- Retrospective review of hospital records for Type 1 DM patients (n=214) with over one year of insulin therapy.
- Inclusion of a sub-study (n=14) of patients newly started on insulin.
- Analysis of HbA1c measurements and clinical data from February 1992 to May 1997.
Main Results:
- The coefficient of variation (CV) for intra-individual HbA1c was 8.8% +/- 3.7% after one year on insulin.
- Higher CV was associated with higher baseline HbA1c and younger age (P < 0.05).
- Most patients (50% and 83.6%) showed HbA1c differences below 1% and 2% respectively between first and last measurements.
Conclusions:
- HbA1c levels demonstrate remarkable stability within individual Type 1 DM patients over time.
- Early HbA1c measurements after initiating insulin therapy serve as a significant predictor of subsequent glycemic control.
Aims:
Patients with Type 1 diabetes mellitus (DM) appear to have remarkably stable HbA1c levels, regardless of the need for improvement. The purpose of the present study was therefore to study predictors of intra-individual variability of the HbA1c level together with changes in HbA1c over time.
Methods:
Hospital records of patients with Type 1 DM seen at our diabetes clinic from February 1992 to May 1997 were reviewed for HbA1c measurements and clinical data. In the main study, 214 patients who had been on insulin for more than 1 year, and in a sub-study, 14 patients newly started on insulin, were included.
Results:
The coefficient of variation (CV) of the intra-individual HbA1c measurements, after at least 1 year of insulin, was 8.8 +/- 3.7% (mean +/- SD). There was a positive association between the CV and the HbA1c measurement at inclusion in the study (P < 0.05), and also a negative association between the CV and age (P < 0.05). Fifty per cent of the patients had a difference between first and last HbA1c below 1%, and 83.6% had a difference below 2%. In the sub-study, there was a positive association between the mean HbA1c value the first year on insulin (excluding the first 3 months) and the last HbA1c measurement (P < 0.01).
Conclusions:
The HbA1c levels in individual patients remain remarkably stable over time. Furthermore, the HbA1c level shortly after starting insulin is a predictor of future glycaemic control.