Background: Good glycemic control prevents long-term complications of microvascular and macrovascular diseases in type 1 diabetes (T1DM).
We aimed to investigate whether our patients had A1c values <7.5% as recommended by ISPAD and how therapy modality, duration of diabetes and pubertal status affected the metabolic control of our patients. We also set out to compare our quality of care with our results of 2008 and with other published data.
Methods: In 2017/18, we enrolled all patients with T1DM who were followed by the outpatient clinic of the University Children's Hospital Bern over a period of 6 months in an observational cross-sectional study. Each patient was assessed once during the observational period, including demographic and clinical data (sex, age, diabetes duration, pubertal status, insulin treatment modality, use of continuous glucose monitoring (CGM), A1c levels).
Results: 160 patients participated in the study, 41% (n=82) were boys and 49% (n=72) were girls. Patients had a mean age (SD) at time of visit of 12.6 (3.5) years (range 2-17 years) and a mean duration (SD) of diabetes of 4.6 (3.6) years (range 1-16 years). Most patients, 63% (n=100) received functional insulin treatment, 29% (n=47) used insulin pump and 8% (n=13) injected insulin on multiple times per day (twice-daily/three-dose). CGM devices were used by 43% (n=68) of patients in their diabetes management. Mean A1c was 8% and 71% had A1c >7.5%. Compared to results from our hospital from 2008, A1c was slightly higher (8% vs 7.6%), but more patients had diabetes for >2 years (80% vs 47%). Patients with T1DM duration >2 years had more often A1c levels above 7.5 % than patients with duration <2 years (P<0.001). A1c values were significantly lower (P<0.05) in patients using CGM devices (7.8% vs 8%). A1c values did not differ between prepubertal and pubertal patients or insulin treatment modality (functional insulin treatment, insulin pump or multiple daily injections).
Conclusion: The overall glycemic control was poorer 2017/2018 than in our study from 2008. This may be due to the higher percent of patients with diabetes duration >2 years, thus with more patients out of the remission phase. Patients wearing CGM devices performed better. Unfortunately, our patients in Bern did not reach the target A1c set by ISPAD, similar to results of other diabetes centres in Europe and the United States. This highlights the importance of regular consultations and extended use of CGM.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology