Introduction and objective: Early glycaemic control is predictive of long-term control. Children who present with diabetic ketoacidosis (DKA) at the time of type 1 diabetes diagnosis are at risk for poorer long-term glycaemic control. Intensive education and support with multidisciplinary team (MDT) input is vital to overcoming these outcomes. In this retrospective analysis, we compared 6 month-HbA1C outcomes in children with and without DKA at diagnosis.
Methods: All newly diagnosed children presenting to a large university teaching hospital over a 2-year period (Dec 2014 to Nov 2016) were included in the study (n=57). All children received intensive MDT support geared towards rapidly accomplishing glycaemic goals within 3 to 6 months of diagnosis. Basal-Bolus therapy with multiple daily injections (MDI) with insulin adjustment according to carbohydrate counting was commenced in all patients, prior to discharge. Children were supported to achieve glycaemic goals through a tailored approach including, as appropriate, rapid conversion to insulin pump therapy and glucose sensing using Continuous Glucose Monitoring (CGM) with alarms or Flash glucose monitoring, in addition to clinic, home and school visits and psychological support. HbA1C outcomes at 6 months after diagnosis were compared among children who presented in DKA vs. children who were not in DKA.
Results: There was a marked uptake of FGS/CGM use from 15% to 53% from 2015 to 2016, following paediatric approval.
|n||16 (28%)||41 (72%)||57|
|<5 years||4 (25%)||7(17%)||11(19%)|
|Median HbA1c (diagnosis)/mmol per mol||118||115||115|
|Median HbA1c (6mo)/mmol per mol||51.5||49.0||51|
|<58 mmol/mol by 6mo||11 (69%)||29(70%)||70%|
|Pump use by 3mo||3 (19%)||13(32%)||16 (28%)|
|Pump use by 6mo||6(37.5%)||19(46%)||25 (44%)|
|CGM with alarms||1(6%)||3(7%)||4 (7%)|
|Flash Glucose Monitoring||7 (44%)||9(22%)||16 (28%)|
Conclusion: A large proportion of patients continue to present in DKA, however DKA at presentation is not a barrier to achieving early good glycaemic control. Multimodal intensive therapy tailored to the children and families needs is an effective strategy for achieving control in both groups.
22 - 24 Nov 2017
British Society for Paediatric Endocrinology and Diabetes