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Title: Challenges in the management of younger adults with type 1 diabetes in hospital outpatient and inpatient settings
Author: Saunders, Simon
ISNI:       0000 0004 2712 4919
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2009
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This thesis examines the challenges of managing a population of patients with type 1 diabetes who initially attended a hospital outpatient clinic between 1991 and 1996. These 386 patients are subsequently reviewed in 2001 and 2006. The continued attendance at the clinic, level of glycaemic control and prevalence of microvascular and macrovascular complications are assessed. In demonstrating the outcomes of this cohort of patients they are compared to the patients within the landmark study The Diabetes Control and Complications Trial (DCCT). The DCCT showed conclusively that good glycaemic control decreased the risk of developing microvascular complications when compared to those patients with less tight glycaemic control. The findings of this study definitively demonstrated the benefits of good glycaemic control. What was also apparent, but a less publicised finding of this trial was the increase in episodes of hypoglycaemia and the weight gain seen in the group with intensive control arm. How do patients in the ‘real-world’ compare to those patients within the DCCT study, is such good control achievable outside the setting of a clinical trial? The outcomes of the patients attending the younger adult diabetes clinic are demonstrated to be similar to those patients in the DCCT who were controlled conventionally, despite encouragement to adopt an intensive insulin regime and offered regular clinical review from both diabetes specialist nurses and consultant. The potential causes for the differences in glycaemic control between an outpatient clinic and those patients in the DCCT are explored. The thesis also examines the difficulties in managing the small numbers of patients with type 1 diabetes who are hospital inpatients. In particular, a group of patients with diabetes who are also intravenous drug abusers are studied. This group are compared to other inpatients and the study clearly shows episodes of frequent admissions and very high mortality rates in the study group. In conclusion the thesis highlights the many problems which exist when trying to manage type 1 diabetes in the outpatient setting including clinic non-attendance, prevalence of other medical problems and limiting factors such as weight gain and hypoglycaemia. Discussion is also made of ways in which to address these issues and improve control for this group of patients.
Supervisor: MacFarlane, Ian Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
Keywords: R Medicine (General)