Introduction: To maintain an average HbA1c of less than 48 mmol/mol requires good diabetes control throughout the year. School holidays take on average 13 weeks (25%) of the year in the UK, therefore good control in holidays as well as term-time is paramount. Little work has been done in this area but it has been suggested diabetes control may be worse during holidays. This study aimed to retrospectively compare diabetes control between term time and the school holidays.
Methodology: All school aged children with type 1 diabetes, being managed by our centre and attending school within the Sheffield catchment area were entered into the study. Demographic data from the hospital records was recorded. DIASEND download data routinely obtained at each clinic appointment was reviewed for the duration of the summer and Christmas holidays during the 20152016 school year. DIASEND data for the same period after each holiday was also collected.
Results: One hundred and twenty children (median age 11years, 43% pump users) had data available for analysis. Daily mean blood glucose was significantly higher for both the Christmas and summer holidays (10.6 and 11.0 mmol/l respectively) compared to the term-time (10.1 and 10.1 mmol/l P<0.01). During the Christmas holiday children did fewer blood tests per day (5.4 vs 5.9, P<0.01), with more readings above target (53% vs 47% P<0.01). During the summer holidays children did a similar number of tests to the term time (5.3 vs 5.4 P=0.5) but still had significantly more results above the target range (50% vs 46% P<0.01). Those using insulin pumps had no difference in the average daily insulin used or the number of boluses given between term-time and either holiday.
Conclusion: Diabetes control in children and young people with type one diabetes appears to worsen during the school holidays. A 0.5 mmol/l difference in mean blood glucose equates to approximately a 4 mmol/mol difference in HbA1c. This highlights the need for education to equip patients and their families to adjust insulin regimes for changes in routine.