Background: Many children with type 1 diabetes (T1D) are asked to measure blood glucose (BG) 46 times a day routinely to adjust insulin dosages. There is no evidence though that such high frequency is beneficial to HbA1C or glycemic profile, although this is often claimed.
Objectives: We challenged the more BG measurements, the better control dogma for alleviation of T1D burden in child life and evaluation of HbA1C.
Patients: During 3 years, we studied 100 children (aged 515 years with T1D >6 months) with HbA1C < 9% at entry and no selection based on socio-economic criteria. Users of insulin pumps were excluded.
Methods: Patients were asked to measure 20 BG monthly, concentrated over a 10-day period chosen to be representative of usual childs life, including five measurements at four different times: 0730 h, 1200 h, 1630 h, 21302230 h, then get expert advice through phone calls or e-mail at the end of the 10-day period. Phone calls were handled by doctors (CB, ALC, PB) and specialized nurses (BA, PL). Patients were seen at outpatient visits every 3 months with HbA1c measurement and could give emergency calls ad libitum.
Results: Studied children measured 19±3 BG per month (instead of 120180 with common recommendations). Advices were about insulin doses, place and timing of injections, diet, special events. Mean HbA1c was 7.7±0.3% (vs 7.8±0.3% at entry). 0.6±0.3 severe hypoglycaemia occurred per studied year (unchanged). Ketoacidosis was not observed. QoL of the parents and child was significantly improved.
Conclusion: Multiplication of BG measurements is not synonymous of good control. Free, easy-to-reach, frequent expert guidance is more important.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology