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Variation in type 1 diabetes care of children and young people

Charalampopoulos, Dimitrios; (2018) Variation in type 1 diabetes care of children and young people. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Background: For children with type 1 diabetes (T1D), achieving optimal glycaemic control is vital in reducing the risk of vascular complications. Despite national guidelines, many children fail to achieve target glycaemic goals. The thesis aimed to explore how HbA1c, an important indicator of diabetes control, is distributed within and between clinics and also investigate the role of several aspects of diabetes services. Methods: Variation in children’s HbA1c levels was analysed cross-sectionally and longitudinally via multilevel linear regression models using audit data from 41,860 children <19 years with T1D in England and Wales collected between 2005 and 2014. Workforce data were also collected across 175 UK services in 2014 to explore links between workforce features and glycaemic control. Finally, data from 64,666 children with T1D were analysed to compare variation in HbA1c between England and Wales and six other high-income countries in Europe and the USA. Results: Differences between clinics accounted for 4-5% of the total variation in children’s glycaemic control, with variation within clinics being much more important. Children who attended clinics with less variable glycaemic levels had better glycaemic control [lower HbA1c by 9.8 mmol/mol (95% CI 8.2 to 11.5), per 10 mmol/mol decrease in clinic HbA1c-SD]. Staffing levels varied considerably between the UK nations and only 43% of services provided 24-h access to advice from the team. However, staffing levels, clinic size, and regional networks made a limited contribution to explaining levels of HbA1c. Population average HbA1c levels in England and Wales decreased by 6 mmol/mol between 2005 and 2014, however performance was poor when compared with Nordic countries. Discussion: Nationwide improvements in glycaemic control might best be achieved not only by narrowing clinic differences but also by adopting a “whole system” approach that encourages changes in all clinics, no matter how well they perform.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Variation in type 1 diabetes care of children and young people
Event: UCL (University College London)
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2018. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. - Third party copyright material has been removed from this e-thesis.
UCL classification: UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10063733
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