使用FreeStyle Libre的1型糖尿病患者先前的结构化教育出勤率以及与HbA1c和低血糖意识的关系:来自英国临床糖尿病学家协会(ABCD)全国审计的见解

IF 0.4 Q4 ENDOCRINOLOGY & METABOLISM British Journal of Diabetes Pub Date : 2021-09-16 DOI:10.15277/bjd.2021.308
N. Shah, Harshal Deshmukh, E. Wilmot, J. Patmore, P. Choudhary, Peter Christian, R. Herring, N. Furlong, S. Saunders, P. Narendran, D. Barnes, C. Walton, R. Ryder, T. Sathyapalan
{"title":"使用FreeStyle Libre的1型糖尿病患者先前的结构化教育出勤率以及与HbA1c和低血糖意识的关系:来自英国临床糖尿病学家协会(ABCD)全国审计的见解","authors":"N. Shah, Harshal Deshmukh, E. Wilmot, J. Patmore, P. Choudhary, Peter Christian, R. Herring, N. Furlong, S. Saunders, P. Narendran, D. Barnes, C. Walton, R. Ryder, T. Sathyapalan","doi":"10.15277/bjd.2021.308","DOIUrl":null,"url":null,"abstract":"Background: Dose Adjustment For Normal Eating (DAFNE) is the gold standard National Institute for Health and Care Excellence (NICE) recommended structured education programme that promotes self-management in people living with type 1 diabetes (T1D). We have recently shown that FreeStyle Libre (FSL) is associated with improved haemoglobin A1c (HbA1c) and hypoglycaemia awareness.\nAims: To explore the effect of structured education including DAFNE on HbA1c and GOLD score when combined with FSL use.\nMethods: The ABCD national audit data on FSL users were used to conduct this prospective longitudinal study. The Stu- dent’s t test was used to compare the baseline and follow-up HbA1c and a change in the GOLD score for hypoglycaemia awareness. The baseline demographic and clinical characteristics of the study population were compared using ANOVA. Linear regression analysis identified predictors of change in HbA1c with FSL use.\nResults: The study consisted of 14,880 people living with insulin-dependent diabetes mellitus (IDDM), 97% of whom had T1D, of which 50% were female, with a mean±SD base- line HbA1c of 70±18 mmol/mol and baseline body mass index (BMI) of 25.3±6.2 kg/m2. Follow-up data for HbA1c were avail- able for 6,446 participants while data for GOLD score were available for 5,057 participants. The study population was divided into three groups: 6,701 people with no prior structured education (Group 1), 3,964 with other structured education (Group 2), and 4,215 had previously attended DAFNE structured education (Group 3). Groups 2 and 3 who had previously attended structured education had a lower initial HbA1c than those in Group 1 (p<0.0001). However, there was a significant but similar magnitude of the fall in HbA1c across all groups (−8.10 mmol/mol vs −6.61 mmol/mol vs −6.22 mmol/mol in Groups 1, 2 and 3, respectively), with p (ANOVA)=0.83. Similarly, the decline in GOLD score was comparable in Groups 1, 2 and 3 (−0.33 vs −0.30 vs −0.34, respectively), with p (ANOVA)=0.43. Linear regression analysis identified higher baseline HbA1c (β=0.585, p<0.0001), number of FSL scans over 14 days (β=−0.026, p=0.00135) and other structured education (β=−1.207, p=0.02483) as predictors of HbA1c reduction. Prior DAFNE training was not associated with improved HbA1c reduction in the linear regression model.\nConclusions: FSL use was associated with improvements in HbA1c and GOLD score. Although DAFNE is an evidence- based intervention to improve outcomes in those with T1D, DAFNE attendance prior to commencing FSL did not influence HbA1c or GOLD score outcomes when compared with FSL use alone. Other structured education was identified as a predictor of HbA1c reduction when combined with FSL use.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.4000,"publicationDate":"2021-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":"{\"title\":\"Previous structured education attendance and the relationship with HbA1c and hypoglycaemia awareness in people living with type 1 diabetes mellitus using FreeStyle Libre: insights from the Association of British Clinical Diabetologists (ABCD) Nationwide Audit\",\"authors\":\"N. Shah, Harshal Deshmukh, E. Wilmot, J. Patmore, P. Choudhary, Peter Christian, R. Herring, N. Furlong, S. Saunders, P. Narendran, D. Barnes, C. Walton, R. Ryder, T. Sathyapalan\",\"doi\":\"10.15277/bjd.2021.308\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background: Dose Adjustment For Normal Eating (DAFNE) is the gold standard National Institute for Health and Care Excellence (NICE) recommended structured education programme that promotes self-management in people living with type 1 diabetes (T1D). We have recently shown that FreeStyle Libre (FSL) is associated with improved haemoglobin A1c (HbA1c) and hypoglycaemia awareness.\\nAims: To explore the effect of structured education including DAFNE on HbA1c and GOLD score when combined with FSL use.\\nMethods: The ABCD national audit data on FSL users were used to conduct this prospective longitudinal study. The Stu- dent’s t test was used to compare the baseline and follow-up HbA1c and a change in the GOLD score for hypoglycaemia awareness. The baseline demographic and clinical characteristics of the study population were compared using ANOVA. Linear regression analysis identified predictors of change in HbA1c with FSL use.\\nResults: The study consisted of 14,880 people living with insulin-dependent diabetes mellitus (IDDM), 97% of whom had T1D, of which 50% were female, with a mean±SD base- line HbA1c of 70±18 mmol/mol and baseline body mass index (BMI) of 25.3±6.2 kg/m2. Follow-up data for HbA1c were avail- able for 6,446 participants while data for GOLD score were available for 5,057 participants. The study population was divided into three groups: 6,701 people with no prior structured education (Group 1), 3,964 with other structured education (Group 2), and 4,215 had previously attended DAFNE structured education (Group 3). Groups 2 and 3 who had previously attended structured education had a lower initial HbA1c than those in Group 1 (p<0.0001). However, there was a significant but similar magnitude of the fall in HbA1c across all groups (−8.10 mmol/mol vs −6.61 mmol/mol vs −6.22 mmol/mol in Groups 1, 2 and 3, respectively), with p (ANOVA)=0.83. Similarly, the decline in GOLD score was comparable in Groups 1, 2 and 3 (−0.33 vs −0.30 vs −0.34, respectively), with p (ANOVA)=0.43. Linear regression analysis identified higher baseline HbA1c (β=0.585, p<0.0001), number of FSL scans over 14 days (β=−0.026, p=0.00135) and other structured education (β=−1.207, p=0.02483) as predictors of HbA1c reduction. Prior DAFNE training was not associated with improved HbA1c reduction in the linear regression model.\\nConclusions: FSL use was associated with improvements in HbA1c and GOLD score. Although DAFNE is an evidence- based intervention to improve outcomes in those with T1D, DAFNE attendance prior to commencing FSL did not influence HbA1c or GOLD score outcomes when compared with FSL use alone. Other structured education was identified as a predictor of HbA1c reduction when combined with FSL use.\",\"PeriodicalId\":42951,\"journal\":{\"name\":\"British Journal of Diabetes\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":0.4000,\"publicationDate\":\"2021-09-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"British Journal of Diabetes\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.15277/bjd.2021.308\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"British Journal of Diabetes","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.15277/bjd.2021.308","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 1

摘要

背景:正常饮食剂量调整(DAFNE)是国家健康与护理卓越研究所(NICE)推荐的结构化教育计划的金标准,旨在促进1型糖尿病患者(T1D)的自我管理。我们最近发现FreeStyle Libre (FSL)与改善血红蛋白A1c (HbA1c)和低血糖意识相关。目的:探讨包括DAFNE在内的结构化教育与FSL联合使用对HbA1c和GOLD评分的影响。方法:采用ABCD国家审计数据对FSL使用者进行前瞻性纵向研究。Stu- dent’s t检验用于比较基线和随访HbA1c以及低血糖认知的GOLD评分的变化。使用方差分析比较研究人群的基线人口学和临床特征。线性回归分析确定了使用FSL后HbA1c变化的预测因子。结果:该研究纳入了14880例胰岛素依赖型糖尿病(IDDM)患者,其中97%为T1D,其中50%为女性,平均±SD基线HbA1c为70±18 mmol/mol,基线体重指数(BMI)为25.3±6.2 kg/m2。随访的HbA1c数据为6,446名参与者,GOLD评分数据为5,057名参与者。研究人群分为三组:6,701人没有先前的结构化教育(第一组),3,964人接受过其他结构化教育(第二组),4,215人以前参加过DAFNE结构化教育(第三组)。先前参加过结构化教育的第2组和第3组的初始HbA1c低于第一组(p<0.0001)。然而,在所有组中,HbA1c的下降幅度显著但相似(1、2和3组分别为- 8.10 mmol/mol vs - 6.61 mmol/mol vs - 6.22 mmol/mol), p(方差分析)=0.83。同样,1、2和3组的GOLD评分下降具有可比性(分别为- 0.33 vs - 0.30 vs - 0.34), p(方差分析)=0.43。线性回归分析发现,较高的基线HbA1c (β=0.585, p<0.0001)、14天内FSL扫描次数(β= - 0.026, p=0.00135)和其他结构化教育(β= - 1.207, p=0.02483)是HbA1c降低的预测因子。在线性回归模型中,先前的DAFNE训练与改善的HbA1c降低无关。结论:FSL使用与HbA1c和GOLD评分的改善相关。虽然DAFNE是一种基于证据的干预措施,可以改善T1D患者的预后,但与单独使用FSL相比,在开始FSL之前参加DAFNE并不影响HbA1c或GOLD评分结果。当与FSL联合使用时,其他结构化教育被确定为HbA1c降低的预测因子。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Previous structured education attendance and the relationship with HbA1c and hypoglycaemia awareness in people living with type 1 diabetes mellitus using FreeStyle Libre: insights from the Association of British Clinical Diabetologists (ABCD) Nationwide Audit
Background: Dose Adjustment For Normal Eating (DAFNE) is the gold standard National Institute for Health and Care Excellence (NICE) recommended structured education programme that promotes self-management in people living with type 1 diabetes (T1D). We have recently shown that FreeStyle Libre (FSL) is associated with improved haemoglobin A1c (HbA1c) and hypoglycaemia awareness. Aims: To explore the effect of structured education including DAFNE on HbA1c and GOLD score when combined with FSL use. Methods: The ABCD national audit data on FSL users were used to conduct this prospective longitudinal study. The Stu- dent’s t test was used to compare the baseline and follow-up HbA1c and a change in the GOLD score for hypoglycaemia awareness. The baseline demographic and clinical characteristics of the study population were compared using ANOVA. Linear regression analysis identified predictors of change in HbA1c with FSL use. Results: The study consisted of 14,880 people living with insulin-dependent diabetes mellitus (IDDM), 97% of whom had T1D, of which 50% were female, with a mean±SD base- line HbA1c of 70±18 mmol/mol and baseline body mass index (BMI) of 25.3±6.2 kg/m2. Follow-up data for HbA1c were avail- able for 6,446 participants while data for GOLD score were available for 5,057 participants. The study population was divided into three groups: 6,701 people with no prior structured education (Group 1), 3,964 with other structured education (Group 2), and 4,215 had previously attended DAFNE structured education (Group 3). Groups 2 and 3 who had previously attended structured education had a lower initial HbA1c than those in Group 1 (p<0.0001). However, there was a significant but similar magnitude of the fall in HbA1c across all groups (−8.10 mmol/mol vs −6.61 mmol/mol vs −6.22 mmol/mol in Groups 1, 2 and 3, respectively), with p (ANOVA)=0.83. Similarly, the decline in GOLD score was comparable in Groups 1, 2 and 3 (−0.33 vs −0.30 vs −0.34, respectively), with p (ANOVA)=0.43. Linear regression analysis identified higher baseline HbA1c (β=0.585, p<0.0001), number of FSL scans over 14 days (β=−0.026, p=0.00135) and other structured education (β=−1.207, p=0.02483) as predictors of HbA1c reduction. Prior DAFNE training was not associated with improved HbA1c reduction in the linear regression model. Conclusions: FSL use was associated with improvements in HbA1c and GOLD score. Although DAFNE is an evidence- based intervention to improve outcomes in those with T1D, DAFNE attendance prior to commencing FSL did not influence HbA1c or GOLD score outcomes when compared with FSL use alone. Other structured education was identified as a predictor of HbA1c reduction when combined with FSL use.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
British Journal of Diabetes
British Journal of Diabetes ENDOCRINOLOGY & METABOLISM-
自引率
16.70%
发文量
15
期刊最新文献
ABCD News Congenital hyperinsulinism: a family case report factors predicting glucose and weight response to injectable semaglutide (Ozempic): real-world data from the Association of British Clinical Diabetologists’ audit programme Fibrates: past history or renaissance? PCSK9 inhibitor therapy: delayed-onset cutaneous reactions
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1