Clinical, behavioural and social indicators for poor glycaemic control around the time of transfer to adult care: a longitudinal study of 126 young people with diabetes.

AIMS: To describe and compare changes in glycaemic control in young people with Type 1 diabetes over time between the last 2 years in paediatric care and the first 2 years in adult care and to identify risk factors for poor glycaemic control. METHODS: Our retrospective cohort study followed participants aged 14-22 years from 2 years before to 2 years after transfer from paediatric to adult care. Changes in glycaemic control were calculated using repeated measurements. We adjusted for gender, age at diabetes onset, age at transfer, duration of diabetes at transfer, gap (amount of time) between last paediatric and first adult visit, comorbidity, learning disability and/or mental health conditions and family structure. We examined associations between acute hospital admissions, low visit attendance rate, loss to follow-up and baseline HbA1c level. RESULTS: Among 126 participants, the mean HbA1c level was 80 mmol/mol (9.4%) pre-transfer but decreased by an average of 3 mmol/mol (0.3%) each year post-transfer (P = 0.005). Young people with a learning disability and/or a mental health condition had worse glycaemic control (P = 0.041) and the mean HbA1c of those with divorced parents was 14 mmol/mol (1.2%) higher (P = 0.014). Almost one-third of participants were admitted to the hospital for acute diabetes care. Low visit attendance rate, high baseline HbA1c level, learning disability and/or mental health conditions and divorced parents predicted acute hospital admissions. CONCLUSIONS: Glycaemic control improved significantly after transfer to adult care, but the mean HbA1c level remained high. Future interventions should focus on young people with divorced parents, those with a learning disability and/or mental health condition and those who do not attend clinical visits to improve HbA1c levels and thereby reduce hospitalization rates.

Variation in high purity water bacterial and endotoxin concentrations in response to spontaneous changes in total oxidizable carbon content.

The goal of this study is to determine the relationship between transient changes in total oxidizable carbon concentration (TOC), bacterial numbers, and endotoxin concentrations at several serial unit operations in a high purity water system. Bacteria are a dynamic component of any ambient temperature sections in a high purity water system; they are living and growing inhabitants. Their numerical variability over time poses challenging QA/QC problems for many industries using high purity waters for manufacturing, formulation, equipment rinsing, and medical device preparation. Preliminary data (Husted et al., 1994) suggested that a possible relationship existed between spontaneous transient elevations in TOC concentration and total planktonic (free floating) bacterial numbers in high purity waters: rising TOC produced sudden increases in bacterial concentration. If the results collected earlier are reproducible, real time monitoring of TOC stability may offer a gateway measurement permitting estimation of changes in endotoxin and bacterial cell concentration, analyses currently made off line in the laboratory. This correlation would also supply guidance for system operation to produce water with both an enhanced and a reproducible quality.