The effect of deprivation and HbA1c on admission to hospital for diabetic ketoacidosis in type 1 diabetes
Diabetologia - Clinical and Experimental Diabetes and Metabolism, 07/02/2012
Govan L et al. – Women, smokers, those with high HbA1c and those living in more deprived areas have an increased risk of admission to hospital for diabetic ketoacidosis. The effect of deprivation was present even after inclusion of other risk factors. This work highlights that those in poorer areas of the community with high HbA1c represent a group who might be usefully supported to try to reduce hospital admissions.Methods
- The Scottish Care Information – Diabetes Collaboration (SCI-DC), a dynamic national register of all cases of diagnosed diabetes in Scotland, was linked to national data on hospital admissions.
- The authors identified 24,750 people with type 1 diabetes between January 2005 and December 2007.
- They assessed the relationship between HbA1c and quintiles of deprivation with hospital admissions for diabetic ketoacidosis in people with type 1 diabetes adjusting for patient characteristics.
- They identified 23,479 people with type 1 diabetes who had complete recording of covariates.
- Deprivation had a substantial effect on odds of admission to hospital for diabetic ketoacidosis (OR 4.51, 95% CI 3.73, 5.46 in the most deprived quintile compared with the least deprived).
- This effect persisted after the inclusion of HbA1c and other risk factors (OR 2.81, 95% CI 2.32, 3.39).
- Men had a reduced risk of admission to hospital for diabetic ketoacidosis (OR 0.71, 95% CI 0.63, 0.79) and those with a history of smoking had increased odds of admission to hospital for diabetic ketoacidosis by a factor of 1.55 (95% CI 1.36, 1.78).