The Scottish Diabetes Improvement Plan 2014

McKnight, John

doi:10.15277/bjdvd.2015.033

Cited by 3 publications

(3 citation statements)

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“…Apart from insulin pumps, the benefit of other measures to improve glycaemic control remain unclear. The Scottish Government introduced a 2 year funded study to support Psychology in Diabetes, Psychology and Diabetes (PiD-PaD) to improve self-management of diabetes [17] but this psychology support is still not widely available. Structured education, on the other hand, was recently shown to cost-effectively improve glycaemic control with or without insulin pump for adults [18].…”

Section: Discussionmentioning

confidence: 99%

“…In March 2014, the first national comparison of HbA 1c data for the 0–18 years age range appeared and the data have been discussed at the National Paediatric Diabetes Multidisciplinary Team annual meeting since then. Starting in 2014, there was a national campaign to standardise and tighten glycaemic targets for individuals with type 1 diabetes [17] and in January 2016, a national Scottish meeting set several key core targets, which have been cascaded across Scotland with the use of ‘Know your HbA 1c charts’. At present, we are unable to assess these specific measures across the datasets but future studies may look into types of insulin and change between regimens, as well as the emerging expansion of flash glucose monitoring (FGM).…”

Section: Discussionmentioning

confidence: 99%

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Glycaemic control trends in people with type 1 diabetes in Scotland 2004–2016

et al. 2019

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Aims/hypothesis The aim of this work was to examine whether glycaemic control has improved in those with type 1 diabetes in Scotland between 2004 and 2016, and whether any trends differed by sociodemographic factors. Methods We analysed records from 30,717 people with type 1 diabetes, registered anytime between 2004 and 2016 in the national diabetes database, which contained repeated measures of HbA 1c . An additive mixed regression model was used to estimate calendar time and other effects on HbA 1c . Results Overall, median (IQR) HbA 1c decreased from 72 (21) mmol/mol [8.7 (4.1)%] in 2004 to 68 (21) mmol/mol (8.4 [4.1]%) in 2016. However, all of the improvement across the period occurred in the latter 4 years: the regression model showed that the only period of significant change in HbA 1c was 2012–2016 where there was a fall of 3 (95% CI 1.82, 3.43) mmol/mol. The largest reductions in HbA 1c in this period were seen in children, from 69 (16) mmol/mol (8.5 [3.6]%) to 63 (14) mmol/mol (7.9 [3.4]%), and adolescents, from 75 (25) mmol/mol (9.0 [4.4]%) to 70 (23) mmol/mol (8.6 [4.3]%). Socioeconomic status (according to Scottish Index of Multiple Deprivation) affected the HbA 1c values: from the regression model, the 20% of people living in the most-deprived areas had HbA 1c levels on average 8.0 (95% CI 7.4, 8.9) mmol/mol higher than those of the 20% of people living in the least-deprived areas. However this difference did not change significantly over time. From the regression model HbA 1c was on average 1.7 (95% CI 1.6, 1.8) mmol/mol higher in women than in men. This sex difference did not narrow over time. Conclusions/interpretation In this high-income country, we identified a modest but important improvement in HbA 1c since 2012 that was most marked in children and adolescents. These changes coincided with national initiatives to reduce HbA 1c including an expansion of pump therapy. However, in most people, overall glycaemic control remains far from target levels and further improvement is badly needed, particularly in those from more-deprived areas. Electronic supplementary material The online version of this article (10.1007/s00125-019-4900-7) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Glycaemic control trends in people with type 1 diabetes in Scotland 2004–2016

et al. 2019

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“…11 However, except for a publicly reported audit from a pediatric diabetes network in the United Kingdom, the effect of clinical networks has been described only among adults with diabetes. 12,13 Furthermore, the effect of diabetes networks on acute diabetes-related complications and on the socioeconomic and geographic disparities in these outcomes has not been evaluated.…”

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confidence: 99%

Outcomes associated with a pediatric clinical diabetes network in Ontario: a population-based time-trend analysis

et al. 2017

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Background:The Network of Ontario Pediatric Diabetes Programs was implemented in 2001. The objective of this study was to determine whether implementation of the network was associated with a decrease in the risk of acute diabetes-related complications and a reduction in the socioeconomic and geographic disparities in these outcomes. Methods:We conducted a population-based time trend analysis of children (< 18 yr) with diabetes using health administrative databases in Ontario from 1996 to 2011. We determined the relation between network implementation and diabetes-related emergency department visits and hospital admissions using linear mixed-effects models with a Poisson link function.Results: Data for 13 806 children with established diabetes were analyzed. After the network was implemented, there was a significant decrease in the rate per 100 children of emergency department visits (17.0 in 2001 v. 10.00 in 2011, p < 0.001) and hospital admissions (8.8 v. 5.0, p < 0.001). The decrease was most significant for those in the lowest socioeconomic quintile and in urban areas. After network implementation, children in the lowest socioeconomic quintile remained at higher risk than those in the highest socioeconomic quintile for emergency department visits (adjusted rate ratio [RR after ] 1.77 [95% confidence interval (CI) 1.55 to 2.03]) and hospital admissions (RR after 2.11 [95% CI 1.77 to 2.52]). However, the yearly decrease in rates of emergency department visits and hospital admissions for the lowest compared to the highest socioeconomic quintile shifted toward a decreasing disparity after network implementation (p < 0.05). Before the network was implemented, geographic location was not associated with outcomes. After implementation, the risk of emergency department visits among patients from urban areas was significantly lower than that among patients from rural areas. Interpretation:The establishment of a pediatric diabetes network was associated with better health outcomes, particularly for patients of lower socioeconomic status. Further work is needed to address the health care needs of those in rural areas. Abstract Researchof Health and Long-Term Care, consists of 35 specialized pediatric diabetes centres. Each centre provides, at a minimum, access to a team consisting of physicians, nurses, dietitians and social workers with training in diabetes care. 15 The workforce in these centres varies from generalists (family physicians, pediatricians) to pediatric endocrinologists (at academic centres), and all of the community centres are affiliated with 1 of the 5 academic pediatric centres. 15 The overall goal of the network is to promote linkages among the centres, assist with the development and dissemination of resources and guidelines, and provide support and infrastructure for implementing evidence-based care and for coordinating services, while promoting consistency in standards of practice through professional development. To date, accountability measures for the network have not included patient outcomes...

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Discussion and Conclusion

Braithwaite¹

2017

Health Systems Improvement Across the Globe

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The Scottish Diabetes Improvement Plan 2014

Cited by 3 publications

References 7 publications

Glycaemic control trends in people with type 1 diabetes in Scotland 2004–2016

Glycaemic control trends in people with type 1 diabetes in Scotland 2004–2016

Outcomes associated with a pediatric clinical diabetes network in Ontario: a population-based time-trend analysis

Discussion and Conclusion

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