Exploring HbA1c variation between Australian diabetes centres: The impact of centre-level and patient-level factors

• Published in: PloS one 2022-02, Vol.17 (2), p.e0263511
• Main Authors: Quigley, Matthew, Earnest, Arul, Szwarcbard, Naomi, Wischer, Natalie, Andrikopoulos, Sofianos, Green, Sally, Zoungas, Sophia
• Format: Article
• Language: English
• Subjects: Adult; Aged; Australia; Biology and life sciences; Blood pressure; Care and treatment; Cigarette smoking; Cross-Sectional Studies; Data collection; Delivery of Health Care; Diabetes; Diabetes mellitus; Diabetes mellitus (insulin dependent); Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 2 - blood; Disease prevention; Drug addiction; Endocrinology; Ethics; Female; Genetic aspects; Glucose; Glycated Hemoglobin - biosynthesis; Health aspects; Health care; Health Services, Indigenous - standards; Hemoglobin; Humans; Linear Models; Male; Measurement; Medicine and Health Sciences; Middle Aged; Patients; People and Places; Practice Guidelines as Topic; Preventive medicine; Primary care; Public health; Reproducibility of Results; Smoking; Smoking Cessation; Social Sciences; Statistics; Supervision; Teachers; Variation
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0263511

Increasing global diabetes incidence has profound implications for health systems and for people living with diabetes. Guidelines have established clinical targets but there may be variation in clinical outcomes including HbA1c, based on location and practice size. Investigating this variation may help identify factors amenable to systemic improvement interventions. The aims of this study were to identify centre-specific and patient-specific factors associated with variation in HbA1c levels and to determine how these associations contribute to variation in performance across diabetes centres. This cross-sectional study analysed data for 5,872 people with type 1 (n = 1,729) or type 2 (n = 4,143) diabetes mellitus collected through the Australian National Diabetes Audit (ANDA). A linear mixed-effects model examined centre-level and patient-level factors associated with variation in HbA1c levels. Mean age was: 43±17 years (type 1), 64±13 (type 2); median disease duration: 18 years (10,29) (type 1), 12 years (6,20) (type 2); female: 52% (type 1), 45% (type 2). For people with type 1 diabetes, volume of patients was associated with increases in HbA1c (p = 0.019). For people with type 2 diabetes, type of centre was associated with reduction in HbA1c (p