Increasing glycaemic burden (GB) associated with diabetes in a UK Health District - a six year follow-up study

Abstract

GB is an integrated measure of hyperglycaemia over time and can be used to quantify risk of complications, and is useful in health economic projections. In a single Health District, we estimated the individual and total GB of diagnosed diabetes over 6 years. GB was calculated from over 91 000 HbA1c measurements between 1996 and 2001, and patients identified using linkage between 3 clinical databases. GB was expressed as months per HbA1c % above threshold of 7.0. Over the study period, diabetes increased from 2.8 % of the population to 5.12% – a 79% increase, while total GB increased by only 55%. Annual GB of individual new patients decreased from 14.7 (CI 13.1–16.3) to 7.9 (7.3–8.6). Among 5027 patients accessing structured care in 1996, average GB increased steadily. The major increase was amongst those initially treated with diet alone – GB 7.0 (6.4–7.7) to 10.1 (9.3–11.0), and with oral hypoglycaemics – 13.8 (13.0–14.5) to 15.9 (15.1–16.8). High GB was a strong predictor of hyperglycaemic emergency. Increased GB was due to treatment failure and increased diagnosis of type 2 diabetes. Effective early intervention would reduce the burden of the disease and decrease emergency admissions.