ESPE Abstracts

Background: The management of type 1 diabetes is complex, requires a multidisciplinary team and knowledge of the possible advantages of new technologies such as insulin bolus calculators.

Aims and objectives: To assess if the use of an automated bolus calculator glucometer Accu-Check Aviva Expert® improves the diabetes control in paediatric patients in multiple daily injections (MDI). To identify which patients benefit most from its use.

Methods: We evaluated 41 diabetic patients treated with MDI (mean age 14.15±3.4 years, 53.7% male) using the calculator. Metabolic control (HbA1c, DCA, Siemens®) and glycaemic variability (standard deviation (SD), mean glycaemia (MG) and number of hypoglycaemia) were assessed at baseline and after 6 and 12 months. Patients were classified into three groups: prepubertal group (< 12 years, n=11), pubertal group (13–15 years, n=12) and postpubertal group (>16 years, n=18). We define as sufficient use of the device if the daily frequency of insulin boluses or intake > 2.5.

Results: 75.6% of cases had poor metabolic control at baseline (HbA1c> 7.5%). We have data for 12 months follow-up of 19 patients and 6 months follow-up of 30 patients. 61% use the calculator correctly. Patients with poor metabolic control at baseline had significantly worse glycaemic variability (DS and MG). In the overall sample, HbA1c statistically improved from baseline at the follow-up (initial: 8.4±1.2%DE, 6m: 8.1±1.1%DE, 12m: 7.7±0.6%DE, P 0.001) mostly in pubertal group and in patients with poor metabolic control. There was no improvement in glycaemic variability.

Conclusions: In our study the use of the calculator helped to improve metabolic control, especially in pubertal patients and in patients with poor metabolic control at baseline. The glycaemic variability did not improve, perhaps due to the small sample size and because we don’t have baseline data on glycaemic variability parameters.