A mixed methods study exploring the factors and behaviours that impact on glycaemic control following a structured education programme: the Irish DAFNE Study

Abstract

INTRODUCTION Diabetes is now the commonest non-communicable illness in the world and is associated with significant morbidity and mortality; over 371 million people worldwide have diabetes (IDF 2012a). It is associated with microvascular and macrovasular complications. As there is no diabetes registry in Ireland, it is difficult to establish the true prevalence rates. However, the International Diabetes Federation estimates that there are 191,380 people with diabetes in Ireland (with a prevalence of 6.1% in the population), approximately 7-9% of whom have type 1 diabetes (T1D) (IDF 2012b). Some of the longer-term complications of diabetes can be avoided by maintaining good glycaemic control. Glycosylated haemoglobin (HbA1c) is used to identify the average plasma glucose concentration over a period of approximately 3 months. Best practice would recommend testing HbA1c every 3 months if the person is trying to improve their glycaemic control or every 6 months if glycaemic control is already achieved and they want to maintain it. HbA1c goals usually determine how tight people with type 1 diabetes have to run their blood sugar, which is usually individualised to the person’s treatment needs. Current guidelines recommend a target HbA1c of between 53 mmol/ mol (7%) and 59 mmol/ mol (7.5%) (ADA 2013). Landmark trials such as the Diabetes Complications and Control Trial demonstrated that poorer glycaemic control (higher HbA1c) was associated with an increased risk of some of the complications of diabetes such as retinopathy, however, tighter control (lower HbA1c) was associated with an increase in the frequency of severe hypoglycaemia (Kilpatrick et al 2008). Hypoglycaemia can be very debilitating to those who experience it and can negatively impact on people’s quality of life (Lawton et al 2013). The challenge in day-to-day management of T1D is to find a balance between an acceptable low level of HbA1c without frequent hypoglycaemia.