ESPE Abstracts (2016) 86 P-P1-250

Type 1 Diabetes (T1D) Management with Few Blood Glucose (BG) Measurements but Frequent Free Adjustment of Treatment with Cell Phones or E-mails

Cécile Bibal, Anne Laure Castell, Brigitte Aboumrad, Philippe Lucchini & Pierre Bougnères


Pediatric Endocrinology, Bicêtre, France


Background: Many children with type 1 diabetes (T1D) are asked to measure blood glucose (BG) 4–6 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 5–15 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 child’s life, including five measurements at four different times: 0730 h, 1200 h, 1630 h, 2130–2230 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 120–180 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.

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