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Endocrine Abstracts (2010) 24 OP1.5

University College London Hospital NHS Trust, London, UK.


Clinical trials of multiple dose insulin (MDI) or pump therapy (CSII) suggest a short term effect with a waning of effect over time – the ‘Hawthorn Effect’. This may relate to interest in the patient during the trial or to lack of reinforcement of the education and training programme. We reviewed our experience in this area where we have used a structured education programme for CSII and MDI over the last 6–8 years and used Quality Control Theory to explore changes in glycosylated haemoglobin (HbA1c) with time in our Diabetes Clinic (293 Children and Young People with Diabetes, <19 years, 129 on CSII therapy).

All clinic mean HbA1c for 2009–2010 was 8.2% with 36.4% attaining a HbA1c below 7.5 and 50.4% under 8.0%. Overall CSII achieved a lower HbA1c compared to MDI in both the paediatric (CSII 7.8%; MDI 8.4%) and adolescent age groups (CSII 8.4%; MDI 8.8%). Over the last 26 quarters Control Theory analysis revealed a stable system in both CSII and MDI groups with an average HbA1c of 7.8% (S.D. 1.0) in the CSII group and 9.0% (S.D. 1.5) in the MDI group. During the time period no value fell outwith the 3 sigma boundary. There was a significant decline in the S.D. of values in the CSII over this time period (P=0.005).

These data demonstrate that over a 6 years period both CSII and MDI groups demonstrate a stable system in term of HbA1c. This would imply that the structured education programme coupled with reinforcement maintains diabetes control, appearing to avoid waning of effect over time. The declining S.D. also suggests reduced variability in control in the clinic. Using Quality Control Theory may allow for better definition of the types of intervention that may be of value in the management of children and young people with diabetes.

Volume 24

38th Meeting of the British Society for Paediatric Endocrinology and Diabetes

British Society for Paediatric Endocrinology and Diabetes 

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