Background: To identify areas of improvement in the management of Type 1 Diabetes Mellitus patients by analysing their clinical data.
Methods: Computer records of 333 T1DM patients on follow-up at Tan Tock Seng Hospital from May to October 2017 were reviewed and analysed retrospectively.
Results: The average age of diagnosis is 29.75 years-old, and average BMI was 22.59 kg/m2. 18% of patients had concomitant thyroid disease. 44.7% of patients had positive anti-GAD and 9.9% had positive serum ICAb. 20.7% of patients were misdiagnosed as having T2DM initially. Complications: 39.9% had DKA, 15.9% had hypoglycemia, 39.3% had microvascular and 13.8% had macrovascular complications. 52% of patients achieved the LDL target of 2.6 mmol/l and below. However, only 15.3% of patients have an established insulin-carbohydrate ratio and insulin correction factor that they use when administering their prandial insulin. While patients with established ICR/ICF do not have lower rates of DKA, (31.4% vs 41.5%, P=0.175), they experienced significantly lower rates of microvascular (42.2% vs 23.5%, P=0.012) and macrovascular (15.6% vs 3.9%, P=0.026) complications. It is also observed that patients going for DM classes experienced significantly lower rates of DKA (18.2% vs 44.2% P <0.001), and experienced lower rates of microvascular (20% vs 43.2%, P=0.001) and macrovascular (5.5% vs 15.5%, P=0.049) complications. Only 2.4% of patients are recorded to have been administered influenza or pneumococcus vaccines.
Discussion: There is little variation from the general population statistics in distribution of gender and ethnicity. However, it is noted that the average age of diagnosis is older, with average BMI that nears the upper limit of normal in Asians, rather than a lower BMI. As 18% of patients had thyroid disease, it is worthwhile screening patients for thyroid disease, even if they are asymptomatic, especially if serum antibodies are positive. Although it could be due to a lack of records, vaccination against common infections is still an important aspect of management which must be reinforced to physicians managing T1DM patients.
Conclusion: These findings break the preconceived notions that T1DM is a disease of only the young and/or lean. Vaccinations for common infections need to be encouraged, thyroid function should be screened regularly, and above all, patient education should be the forefront of management to reduce complication rates. These new insights may pave the way to a more holistic and effective management of T1 diabetic patients.
18 - 21 May 2019
European Society of Endocrinology