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Both the frequency of HbA 1c testing and the frequency of self‐monitoring of blood glucose predict metabolic control: A multicentre analysis of 15 199 adult type 1 diabetes patients from G ermany and A ustria
Author(s) -
Schwandt A.,
Best F.,
Biester T.,
Grünerbel A.,
Kopp F.,
Krakow D.,
Laimer M.,
Wagner C.,
Holl R.W.
Publication year - 2017
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.2908
Subject(s) - confounding , medicine , diabetes mellitus , metabolic control analysis , population , type 2 diabetes , hemoglobin a , hemoglobin , endocrinology , environmental health
Background The objective of this study was to examine the association between metabolic control and frequency of haemoglobin A 1c (HbA 1c ) measurements and of self‐monitoring of blood glucose, as well as the interaction of both. Methods Data of 15 199 adult type 1 diabetes patients registered in a standardized electronic health record (DPV) were included. To model the association between metabolic control and frequency of HbA 1c testing or of self‐monitoring of blood glucose, multiple hierarchic regression models with adjustment for confounders were fitted. Tukey‐Kramer test was used to adjust P values for multiple comparisons. Vuong test was used to compare non‐nested models. Results The baseline variables of the study population were median age 19.9 [Q1; Q3: 18.4; 32.2] years and diabetes duration 10.4 [6.8; 15.7] years. Haemoglobin A 1c was 60.4 [51.5; 72.5] mmol/mol. Frequency of HbA 1c testing was 8.0 [5.0; 9.0] within 2 years, and daily self‐monitoring of blood glucose frequency was 5.0 [4.0; 6.0]. After adjustment, a U‐shaped association between metabolic control and frequency of HbA 1c testing was observed with lowest HbA 1c levels in the 3‐monthly HbA 1c testing group. There was an inverse relationship between self‐monitoring of blood glucose and HbA 1c with lower HbA 1c associated with highest frequency of testing (>6 daily measurements). Quarterly HbA 1c testing and frequent self‐monitoring of blood glucose were associated with best metabolic control. The adjusted Vuong Z statistic suggests that metabolic control might be better explained by HbA 1c testing compared to self‐monitoring of blood glucose ( P < .0001). Conclusion This research reveals the importance of quarterly clinical HbA 1c monitoring together with frequent self‐monitoring of blood glucose in diabetes management to reach and maintain target HbA 1c .