Persistent poor glycaemic control in adult Type 1 diabetes. A closer look at the problem

Abstract

Around 25% of the adult Type 1 diabetes population is in persistent poor glycaemic control and thus at increased risk of developing microvascular complications. We here discuss correlates of long-standing poor glycaemic control and review the efficacy of clinical strategies designed to overcome persistent poor control. Only a few studies have identified determinants and correlates of long-standing poor glycaemic control in Type 1 diabetes. There is some evidence implicating genetic factors, as well as lower economic status, and psychological factors, including lack of motivation, emotional distress, depression and eating disorders. Ways of improving glycaemic control include strategies to enable self-management, e.g. motivational strategies, coping-orientated education, psychosocial therapies, and/or intensifying insulin injection therapy plus continuous subcutaneous insulin infusion. Long-standing poor glycaemic control appears to be a heterogeneous and complex phenomenon, for which there is no simple, single solution. Comprehensive psycho-medical assessment in diabetes care may prove useful in tailoring interventions. Further research is warranted, to increase our understanding how psychosocial and biomedical factors, separately and in interaction, determine poor outcomes in Type 1 diabetes.

Nurse-led psychological interventions to improve diabetes control: Assessing competencies

“…Sub-optimal glycaemic control (SOGC) in type 1 diabetes is common despite the effectiveness of intensive insulin therapies, continuous subcutaneous insulin infusion pumps and structured education programs [1][2][3]. Factors which can contribute to suboptimal glycaemic control are diverse and include biological factors such as subcutaneous insulin absorption, liver function and autonomic arousal, psychological barriers such as diabetes-related anxieties around hypoglycaemia, complications, self-injecting and glucose self-testing, weight gain and low mood [4][5][6][7][8].…”

Stress and Diabetes: A Review of the Links

“…[12][13][14][15] This potential influence is important, not only for the often debilitating effects poor blood glucose control can have on daily life, but also because of the known association between chronically high blood glucose levels and the development of diabetes complications. 16 It is a complex area of research, much of it having been conducted in children and adolescents, with fewer studies in adults or in those with type 2 diabetes, and using a number of different measurement tools.…”

Eating Disorders in Girls and Women With Type 1 Diabetes: A Longitudinal Study of Prevalence, Onset, Remission, and Recurrence

“…This is an important mediator of the association of DEB and EDs with poorer metabolic control (5,6) and contributes to an increased risk of a range of short-term and long-term diabetes-related medical complications. These include abnormal lipid profiles (7), diabetic ketoacidosis (6), retinopathy (8), neuropathy (9), and nephropathy (10), as well as higher than expected mortality (11).…”