Endocrine Abstracts (2013) 32 P797 | DOI: 10.1530/endoabs.32.P797

Improvement in metabolic control of type 1 diabetes mellitus in a tertiary unit: 2005 vs 2012

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

Unit of Endocrinology, Diabetes and Growth, Hospital Pediátrico Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal.

Aim: To define the main predictors of metabolic control in children and adolescents and evaluate its improvement along the years.

Methods: We included children and adolescents with 1DM, with more than two years of disease. Data were collected at 2005 and at 2012. Sex, age and severity at diagnosis, therapy in the last year, age at onset of multiple daily insulin injections (MDII) and continuous subcutaneous insulin infusion (CSII), number of group educational sessions, insulin daily dosis (IDD) and mean HbA1c along last year were collected. Three groups were defined to evaluate metabolic control (1, HbA1c ≤7.5%; 2, HbA1c 7.5–9%; 3, HbA1c ≥9%). Statistic analysis was performed with SPSS®.

Results: We included 243 childrens with 1DM (107 in 2005 and 136 in 2012). There were no differences in sex, age at diagnosis (6.0±3.3 vs 6.6±3.6 years) or duration of illness (6.8±3.3 vs 6.2±3.6 years). Severity at diagnosis was higher in 2005 (P=0.021). In 2005, 34.6% were in conventional therapy and 65.4% in MDII. In 2012, all children were in intensive therapy since diagnosis (75% MDII and 25% CSII). Comparing data from 2005 to 2012, we found statistical difference in number of group educational sessions (1.6±0.9 vs 4.8±2.5; P<0.001), duration of MDII (1.8±2.2 vs 3.5±1.1; P<0.001), IDD (1.04±0.27 vs 0.91±0.22 IU/kg/d; P<0.001), mean HbA1c in the last year (8.7±1.3% vs 7.7±1.0%; P<0.001), and groups of HbA1c (group1=17.8%, 2=52.3%, 3=29.9%; vs group1=47.1%, 2=45.6%, 3=7.4%; P<0.001). In 2012, the children in group 1 had started MDII at younger age (P=0.04) with lower IDD (P=0.02) and had more children in CSII (P<0.001); children in group 3 were older (P=0.04).

Conclusion: There was a clear improvement in metabolic control from 2005 to 2012. The main predictors of greater metabolic control were early onset of MDII and CSII and increase of educational sessions. This reinsures the advantage of intensive insulin therapy since diagnosis.