ESPE Abstracts (2014) 82 P-D-2-3-345

Improvement in Type 1 Diabetes Mellitus Metabolic Control: From Conventional to Functional Insulin Therapy

Joana Serra-Caetano, Sara Ferreira, Helena Lourenço, Lina Aveiro, Nanci Batista, Filomena Freitas, Luísa Simão, Rita Cardoso, Isabel Dinis & Alice Mirante

Pediatric Endocrinology and Diabetology Unit, Coimbra Pediatric Hospital, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal

Background: Type 1 diabetes mellitus (1DM) is a common chronic disease of childhood. Treatment targets the best metabolic control in order to prevent long-term complications.

Objective: To evaluate metabolic control in children and adolescents with 1DM along the years. Methods: Retrospective study including 1DM children and adolescents with more than 2 years of disease. Data were collected at 2005 and at 2012: sex, age at diagnosis, therapy in the last year, number of group educational sessions, insulin daily dosis (IDD) and mean A1c along last year, BMI and lipid profile. Statistic analysis performed with SPSS 21.

Results: We included 243 children with 1DM: 107 in 2005, all in conventional therapy (CT) and 136 in 2012, all in functional therapy (FT) (75% MDII, 25% CSII). There were no differences in sex, age at diagnosis (6.0±3.3 vs 6.6±3.6 years), duration of illness (6.8±3.3 vs 6.2±3.6 years). Comparing data from 2005-CT to 2012-FT, we found statistical difference in number educational sessions (1.6±0.9 vs 4.8±2.5; P<0.001), IDD (1.04±0.27 vs 0.91±0.22 IU/kg per day; P<0.001), mean HbA1c in the last year (8.7±1.3 vs 7.7±1.0%; P<0.001), total cholesterol (4.1±0.82 vs 4.4±0.86 mmol/l; P=0.01) and HDL-cholesterol (1.3±0.45 vs 1.6±0.35 mmol/l; P<0.001) and BMI sds (0.95±0.84 vs 0.43±1.1, P<0,001). In 2005 and 2012 A1c had a positive correlation with: age date of study (r=0.28; P=0.004 and r=0.18; P=0.04); diabetes duration (r=0.25; P=0.008 and r=0.24; P=0.005); IDD (r=0.41; P<0.0001 and r=0.3; P=0.002); total cholesterol (r=0.43; P<0.0001 and r=0.32; P<0.0001) and LDL-cholesterol (r=0.27; P=0.006 and r=0.24; P=0.005). In 2012 we found a negative correlation between A1c and relative duration of FT (r=−0.28; P=0.001).

Conclusion: The relevant changes were FT implementation and educational reinforcement. With FT there was better metabolic control with lower insulin dosis and lower BMI. Longest FT was associated with better metabolic control, reinsuring the advantage of intensive insulin therapy since diagnosis.