Introduction: Continuous Subcutaneous Insulin Infusion (CSII) therapy is an established treatment of Type 1 Diabetes Mellitus (T1DM). NICE recommends a target HbA1c of ≤6.5% to minimise long-term complication risks1. CSII can be considered in patients <12 years and in those with high HbA1c (≥8.5%) on multiple daily insulin injections, despite a high level of care1. The aim of this audit is to review diabetes control over time in T1DM patients managed with CSII at our hospital.
Methods: Retrospective review of diabetes control of T1DM patients managed with CSII at our hospital (Mar 2009Jan 2017). All CSII patients with complete data, namely a locally recorded pre-CSII HbA1c and managed with CSII for at least one full year, were included. Pre-CSII HbA1c indicates mean of up to three HbA1c values prior to initiating CSII therapy; annual CSII HbA1c indicates mean of all HbA1c values recorded for a whole year on CSII.
Results: A total of 57 patients were managed with CSII at our hospital over the last 7 years; seven patients did not meet the inclusion criteria. There was a slight male preponderance (1.08:1) with a mean (S.D.) age at diagnosis/transfer of 7.6 (4.5) years and switching to CSII at 10.2 (4.8) years. The mean (S.D.) pre-CSII HbA1c was 8.4% (1.1) and first year HbA1c on CSII was 7.7% (0.7); thereafter it was 7.7% (0.8), 7.7% (0.9), 7.6% (0.8), 7.7 (0.8), 8.0% (1.3) and 7.6% (0.4) at 2, 3, 4, 5, 6 and 7 years respectively. Sub-group analysis showed that patients with better control pre-CSII generally maintained better control on CSII.
Conclusion: Mean annual HbA1c of CSII patients at our hospital have remained relatively stable over the seven-year study period; other studies however have demonstrated gradual worsening of diabetes control over time2. Patients with better control pre-CSII continued with good control on CSII suggesting additional protective factors within the patient/family context, other than CSII therapy. Due to the small number of patients, especially in the latter years, a larger longitudinal study would be helpful to confirm these findings.
22 - 24 Nov 2017
British Society for Paediatric Endocrinology and Diabetes