Author(s): Ramtoola S., Ploug U.J., Kragh N., Nyeland M.E.
Abstract: Background and aims: The aim of this study was to ascertain the weight, BMI characteristics and comorbidities of adults with newly diagnosed type 1 diabetes (T1D) in the UK and assess the impact of initiating insulin therapy on their glycaemic control and weight profile over the first 5 years after diagnosis. Materials and methods: This study was a non-interventional, retrospective, cohort study utilising data from the UK Clinical Practice Research Datalink (CPRD) database between 2001 and 2013. Patients were selected based on a recorded diagnosis (C10* read codes) of T1D or fulfilling the NHS criteria for T1D, in whom onset of continuous insulin treatment was within 12 months of diagnosis. Patients included were aged 18-85 years, with a body mass index (BMI) of 11-50 kg/m2 and a full medical history of at least 12 months prior to diagnosis (n=2430). Using this dataset, HbA1c and BMI levels were compared at baseline and 12, 24, 36 and 60 months after insulin therapy was initiated. Results: At baseline, patients (63.3% male, 36.7% female) had a mean +/- SD age of 40.8+/-16.1 years, HbA1c of 10.8%+/-3.0, and a BMI of 25.3+/-5.5. Mean BMI and BMI distribution of study patients were comparable to that of the UK general population. Following initiation of insulin therapy, mean HbA1c statistically significantly (only taking inter-subject variation into consideration) declined from 10.8%+/-3.0 to 7.7%+/-2.0 at 12 months (P<0.01), but subsequently statistically significantly increased to 8.1%+/-2.0 at 24 months, remaining stable thereafter at 8.2%+/-1.9 and 8.2%+/-1.7 at 3 and 5 years, respectively (Figure 1). Mean BMI consistently increased from 25.3 +/-5.5 at baseline, to 27.2+/-5.8, 27.4+/-5.7, 27.5+/-5.6, and 27.9+/-5.5 kg/m2 at 1, 2, 3 and 5 years, however, only the increase in the first 12 months was statistically significant (only taking inter-subject variation into consideration). Conclusion: Whilst insulin therapy exerted an initial reduction in HbA1c at 12 months, mean HbA1c at 12 months was still above the NICE targets, and further deteriorated soon after, stabilizing between 2 and 5 years after initiation of treatment. After beginning insulin therapy, T1D patients were susceptible to long-term cumulative weight gain and increase in BMI, with deeper entrenchment into pathophysiological BMI weight categories. This study supports the concept of "glycaemic streaming"and suggests that further intensification of efforts is required right from diagnosis and initiation of insulin therapy to support patients with T1D to achieve and maintain glycaemic control targets. Currently weight control is a side issue in UK T1D patient education and treatment strategies which focus primarily if not almost exclusively on the titration of insulin to achieve HbA1c targets. This study illustrates the need for greater emphasis on weight management in national T1D education programmes. (figure present).
Publication Type: Journal: Conference Abstract