Trends in glycaemic control and morbidity over 10 years in patients with type 1 diabetes mellitus at Inkosi Albert Luthuli Central Hospital

Abstract

Aim: To assess control and morbidity in patients with type 1 diabetes mellitus (T1 attending a tertiary adult diabetes clinic in Durban, South Africa. Methods: A retrospective chart review of all patients with T1D who attended clinic in the years 2006, 2012 and 2015. Clinical and laboratory changes were assessed at an individual patient-level follow-up (IPLF) and whole clinic level (n = 231). Results: In the IPLF study arm (n = 58; 45% Black patients; 62% female; median age 18 years), mean HbA1c [% (mmol/mol)] decreased from 9.9 ± 2.6% (85 ± 28) in 2006 to 8.7 ± 1.5% (72 ± 16) in 2012 (p < 0.001) and to 9.1 ± 1.7% (76 ± 19) in 2015 (p = 0.03); target HbA1c < 7.0% (< 53 mmol/mol) was achieved in 7.1%, 5.3% and 8.3%, respectively. Compared with 2006, in 2015 there was a higher prevalence of retinopathy (10.3% vs. 29.3%, p = 0.004), abnormal glomerular filtration rate (0% vs. 6.9%, p = 0.04) and abnormal serum creatinine (0% vs. 8.6%, p = 0.02). Predictive risk factors for new retinopathy included diabetes duration (OR 1.4; 95% CI 1.0–1.3; p = 0.03) and diastolic blood pressure (OR 1.15; 95% CI 1.0–1.3; p = 0.04). Conclusion: Glycaemic control improved over 10 years, but fell short of recommended targets. Intensive efforts are required to achieve current targets for glycaemic and non-glycaemic control.