Glycaemic streaming in type 1 diabetes: implications for intervention?

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Evidence exists that mean glycaemia in individuals with type 1 diabetes may remain remarkably constant (glycaemic ‘streaming’ or ‘tracking’). We have re-examined this in a group of type 1 patients, to explore whether any subgroups may be more or less amenable to glycaemic improvement.

We made a retrospective analysis between 2003 and 2007 of 181 people with type 1 diabetes. Basic demographic information, and sequential glycated haemoglobin (HbA1c) levels during the five-year follow-up period (2003–2007), were recorded. First (2003) and last HbA1c levels were recorded, and mean HbA1c for the whole period. These were analysed as a total group, by gender, and by glycaemic control (initial HbA1c over or below 64mmol/mol [8.0%]).

Mean age was 41±8 years, diabetes duration 19±9 years, 58% were male, and mean HbA1c was 75±17mmol/mol (9.0±1.6%). Over the study period there was a small improvement in total population mean HbA1c (75±17 to 72±16mmol/mol [9.0±1.6 to 8.7±1.5%], p=0.003). This was accounted for by improvements in male (74±17 to 70±15mmol/mol [8.9±1.6 to 8.6±1.4%], p=0.005) and poorly-controlled (HbA1c ≥65mmol/mol [8.1%]) patients (79±15 to 75±15mmol/mol [9.4±1.4 to 9.0±1.4%], p=0.002). Female and well-controlled (HbA1c ≤64mmol/mol [8.0%]) patients showed no change in mean glycaemia.

Most patients maintained closely similar HbA1c levels over time. Interventions in type 1 diabetes may be more usefully aimed at risk factors rather than glycaemia. Copyright © 2013 John Wiley & Sons.

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