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Type 1 diabetes management and outcomes: A multicenter study in Thailand
Prapai Dejkhamron1,2, Jeerunda Santiprabhob3,4, Supawadee Likitmaskul3,4
1Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Insights
Most Thai type 1 diabetes patients have poor glycemic control. Intensive insulin treatment and frequent self-monitoring of blood glucose improve outcomes, leading to a national program for better diabetes care.
Area of Science:
- Endocrinology
- Public Health
- Diabetes Research
Background:
- The Thai Type 1 Diabetes and Diabetes Diagnosed Before Age 30 Years Registry, Care and Network (T1D-Registry) was established in 2014.
- The registry aimed to assess glycemic control and complications in Thai patients with type 1 diabetes.
Purpose of the Study:
- To evaluate the current status of glycemic control and the prevalence of complications in Thai type 1 diabetes patients.
- To identify factors associated with good glycemic control and reduced complications.
Main Methods:
- Data collected from 1,907 type 1 diabetes patients across 31 hospitals.
- Included demographics, clinical data, self-monitoring of blood glucose (SMBG) frequency, glycemic control (HbA1c), and complication status.
Main Results:
- Mean HbA1c was 9.35±2.41%, with most patients not meeting glycemic targets.
- Intensive insulin treatment was associated with better glycemic control and lower rates of diabetic retinopathy compared to conventional treatment.
- Good glycemic control was linked to age (25 to <45 years), intensive insulin therapy with frequent SMBG, and shorter diabetes duration (1 to <5 years).
Conclusions:
- A significant proportion of Thai type 1 diabetes patients exhibit suboptimal glycemic control.
- Intensive insulin treatment and regular SMBG are crucial for improving outcomes.
- A national program has been initiated to enhance diabetes treatment quality and patient education.
Aims/Introduction:
The Thai Type 1 Diabetes and Diabetes Diagnosed Before Age 30 Years Registry, Care and Network was established in 2014 and involved 31 hospitals. The objective of the registry was to evaluate glycemic control and complications of patients with type 1 diabetes.
Materials And Methods:
Patients' demographics, clinical data, frequencies of daily self-monitoring of blood glucose (SMBG), glycemic control and complications were collected.
Results:
Among the 1,907 type 1 diabetes patients, the mean age was 21.2 ± 11.3 years. The mean glycated hemoglobin level was 9.35 ± 2.41%, with significant variations among age groups (P < 0.001). Conventional insulin treatment and intensive insulin treatment were used in 43 and 57% of patients, respectively. Mean glycated hemoglobin levels were significantly higher in patients treated with conventional insulin treatment compared to those treated with intensive insulin treatment (9.63 ± 2.34 vs 9.17 ± 2.46%, P = 0.002). Compared to the conventional insulin treatment group, significantly more patients in the intensive insulin treatment group achieved good glycemic control (P < 0.001), and fewer had diabetic retinopathy (P = 0.031). The prevalence of microvascular complications increased significantly with age (P < 0.001). Multivariate analysis showed good glycemic control to be associated with age 25 to <45 years, intensive insulin treatment with SMBG three or more times daily and diabetes duration of 1 to <5 years.
Conclusions:
Most Thai type 1 diabetes patients were not meeting the recommended glycemic target. As a result of this study, the national program to improve the quality of diabetes treatment and education has been implemented, and the results are ongoing.
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