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Predictors of Glycemic Control in Children and Adolescents with Type 1 Diabetes in Southwestern Ontario
Abstracts / Can J Diabetes 37 (2013) S13eS84
S77
15.0%), indicating that approximately 40% of diabetes cases are undiagnosed. Conclusions: A substantial proportion of diabetes cases are missed by surveillance methods that use health administrative databases. This finding is concerning because individuals with undiagnosed diabetes are likely to have a delay in treatment and, thus, a higher risk for diabetes-related complications.
This study is based in part on de-identified data provided by the Saskatchewan Ministry of Health. The interpretation and conclusions contained herein do not necessarily represent those of the government of Saskatchewan or the Saskatchewan Ministry of Health.
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225
Incidence and Prevalence of Diabetes in Residents of Saskatchewan Long-Term Care Facilities between 2003 and 2011 KERRY MANSELL*, WASEM ALSABBAGH, XINYA LU, LISA LIX, GARY TEARE, YVONNE SHEVCHUK, DAVID BLACKBURN Saskatoon, SK
Predictors of Glycemic Control in Children and Adolescents with Type 1 Diabetes in Southwestern Ontario TAMARA SPAIC*, JEFFREY L. MAHON, AMARDEEP THIND, STEWART B. HARRIS London, ON
Background: Although the prevalence of diabetes among residents of long-term care facilities (LTCF) is thought to be high, most estimates are based on survey data and few studies have been performed in Canadian facilities. Objective: We aimed to describe the prevalence and incidence of diabetes mellitus among patients newly admitted to LTCF in the province of Saskatchewan between 2003 and 2011. Methods: Administrative databases from the Saskatchewan Ministry of Health were abstracted to identify subjects newly admitted to a LTCF using a 2-year washout period. Subjects were excluded if they resided in a LTCF less than 6 months. We identified diabetes through medication use and/or physician/hospital claims to determine the prevalence of diabetes prior to admission, and also examined the incidence of diabetes within 6 months following admission to a LTCF. Results: Of 8617 newly admitted residents to a LTCF, the mean age was 80.5 years (SD¼12.8) and two thirds (n¼5707) were female. The prevalence of diabetes prior to admission was 21.9% (n¼1889) and the incidence was 2.5% (167/6728). Between 2003 and 2011, the crude prevalence of diabetes increased by 35% (from 17% to 23%) and the crude incidence of diabetes increased by 25% (from 2% to 2.5%). Conclusion: A substantial increase in diabetes prevalence among LTCF was observed over the last decade. This trend will certainly place greater demands on staffing and resources required to adequately manage LTCF residents in the future.
Optimal glycemic control in children with type 1 diabetes (T1D) is essential but often difficult to achieve. There are limited data on factors associated with suboptimal control under “real world” conditions. We performed a population based cohort study (1998 to 2008) using a regional clinical diabetes database at the Children’s Hospital in London, Ontario. Our goal was to identify factors that predicted subsequent attainment of CDA age-specific A1C targets (< 8.5% [0 to 6 years], <8% [6 to 12 years], <7% [>12 years]) in routine clinical practice. Predictors of interest included age, gender, distance from London, family income, diabetes duration, BMI and previous attainment of glycemic control. Relationships between the variables and attainment of target A1C were assessed by multivariable logistic regression within each age category. Included were 996 subjects (52 % male) aged 2 to 20 years with T1D for at least 1 year (mean duration 9 years). The proportion of subjects with A1C in target at the last visit was: 63% <6 years, 44% 6 to 12 years, and 9.8% >12 years. Results of the adjusted analysis are shown in the Table. No predictive factors were found in 6 to 12 years old. Distance from treatment center was predictive in the youngest group, while male gender, longer diabetes duration and higher BMI were factors predictive of target A1C attainment in the adolescents. This largest Canadian study to date has demonstrated that achievement of the target A1C in clinical practice is suboptimal, particularly in the adolescent group with a selected number of factors influencing glycemic control.
Table Adjusted Odds Ratios for the Achievement of Age-specific Target A1C Levels
Gender Male Female Age Distance from London <50 km >50 km Household Income <$57,000 >$57,000 Diabetes duration Body Mass Index A1C at target (in the previous period) No Yes Note: Odds ratio of 1.00 denotes reference category. 95% confidence intervals are shown in the brackets. * denotes p¼0.2 for a stepwise model building entry criteria. N/A not applicable.
Model 1 (Age < 6)
Model 2 (Age 6 e 12)
Model 3 (Age > 12)
n¼123
n¼453
n¼805
1.00 0.64 (0.29e1.41) 1.49 (0.83e2.68)
1.00 1.08 (0.74e1.58) 0.94 (0.82e1.09)
1.00 0.47 (0.29e0.77)* 1.21 (1.04e1.41)
1.00 0.35 (0.16e0.74)*
1.00 0.88 (0.60e1.28)
1.00 1.09 (0.69e1.74)
1.00 0.85 (0.36e1.96) 0.85 (0.58e1.24) 1.10 (0.77e1.59)
1.00 1.18 (0.80e1.73) 1.01 (0.92e1.10) 1.03 (0.98e1.09)
1.00 1.15 (0.71e1.85) 1.13 (1.06e1.21)* 1.06 (1.01e1.12)*
N/A
1.00 1.26 (0.84e1.89)
1.00 1.95 (1.33e2.86)
S77
15.0%), indicating that approximately 40% of diabetes cases are undiagnosed. Conclusions: A substantial proportion of diabetes cases are missed by surveillance methods that use health administrative databases. This finding is concerning because individuals with undiagnosed diabetes are likely to have a delay in treatment and, thus, a higher risk for diabetes-related complications.
This study is based in part on de-identified data provided by the Saskatchewan Ministry of Health. The interpretation and conclusions contained herein do not necessarily represent those of the government of Saskatchewan or the Saskatchewan Ministry of Health.
224
225
Incidence and Prevalence of Diabetes in Residents of Saskatchewan Long-Term Care Facilities between 2003 and 2011 KERRY MANSELL*, WASEM ALSABBAGH, XINYA LU, LISA LIX, GARY TEARE, YVONNE SHEVCHUK, DAVID BLACKBURN Saskatoon, SK
Predictors of Glycemic Control in Children and Adolescents with Type 1 Diabetes in Southwestern Ontario TAMARA SPAIC*, JEFFREY L. MAHON, AMARDEEP THIND, STEWART B. HARRIS London, ON
Background: Although the prevalence of diabetes among residents of long-term care facilities (LTCF) is thought to be high, most estimates are based on survey data and few studies have been performed in Canadian facilities. Objective: We aimed to describe the prevalence and incidence of diabetes mellitus among patients newly admitted to LTCF in the province of Saskatchewan between 2003 and 2011. Methods: Administrative databases from the Saskatchewan Ministry of Health were abstracted to identify subjects newly admitted to a LTCF using a 2-year washout period. Subjects were excluded if they resided in a LTCF less than 6 months. We identified diabetes through medication use and/or physician/hospital claims to determine the prevalence of diabetes prior to admission, and also examined the incidence of diabetes within 6 months following admission to a LTCF. Results: Of 8617 newly admitted residents to a LTCF, the mean age was 80.5 years (SD¼12.8) and two thirds (n¼5707) were female. The prevalence of diabetes prior to admission was 21.9% (n¼1889) and the incidence was 2.5% (167/6728). Between 2003 and 2011, the crude prevalence of diabetes increased by 35% (from 17% to 23%) and the crude incidence of diabetes increased by 25% (from 2% to 2.5%). Conclusion: A substantial increase in diabetes prevalence among LTCF was observed over the last decade. This trend will certainly place greater demands on staffing and resources required to adequately manage LTCF residents in the future.
Optimal glycemic control in children with type 1 diabetes (T1D) is essential but often difficult to achieve. There are limited data on factors associated with suboptimal control under “real world” conditions. We performed a population based cohort study (1998 to 2008) using a regional clinical diabetes database at the Children’s Hospital in London, Ontario. Our goal was to identify factors that predicted subsequent attainment of CDA age-specific A1C targets (< 8.5% [0 to 6 years], <8% [6 to 12 years], <7% [>12 years]) in routine clinical practice. Predictors of interest included age, gender, distance from London, family income, diabetes duration, BMI and previous attainment of glycemic control. Relationships between the variables and attainment of target A1C were assessed by multivariable logistic regression within each age category. Included were 996 subjects (52 % male) aged 2 to 20 years with T1D for at least 1 year (mean duration 9 years). The proportion of subjects with A1C in target at the last visit was: 63% <6 years, 44% 6 to 12 years, and 9.8% >12 years. Results of the adjusted analysis are shown in the Table. No predictive factors were found in 6 to 12 years old. Distance from treatment center was predictive in the youngest group, while male gender, longer diabetes duration and higher BMI were factors predictive of target A1C attainment in the adolescents. This largest Canadian study to date has demonstrated that achievement of the target A1C in clinical practice is suboptimal, particularly in the adolescent group with a selected number of factors influencing glycemic control.
Table Adjusted Odds Ratios for the Achievement of Age-specific Target A1C Levels
Gender Male Female Age Distance from London <50 km >50 km Household Income <$57,000 >$57,000 Diabetes duration Body Mass Index A1C at target (in the previous period) No Yes Note: Odds ratio of 1.00 denotes reference category. 95% confidence intervals are shown in the brackets. * denotes p¼0.2 for a stepwise model building entry criteria. N/A not applicable.
Model 1 (Age < 6)
Model 2 (Age 6 e 12)
Model 3 (Age > 12)
n¼123
n¼453
n¼805
1.00 0.64 (0.29e1.41) 1.49 (0.83e2.68)
1.00 1.08 (0.74e1.58) 0.94 (0.82e1.09)
1.00 0.47 (0.29e0.77)* 1.21 (1.04e1.41)
1.00 0.35 (0.16e0.74)*
1.00 0.88 (0.60e1.28)
1.00 1.09 (0.69e1.74)
1.00 0.85 (0.36e1.96) 0.85 (0.58e1.24) 1.10 (0.77e1.59)
1.00 1.18 (0.80e1.73) 1.01 (0.92e1.10) 1.03 (0.98e1.09)
1.00 1.15 (0.71e1.85) 1.13 (1.06e1.21)* 1.06 (1.01e1.12)*
N/A
1.00 1.26 (0.84e1.89)
1.00 1.95 (1.33e2.86)