Introduction: Although not directly inherited, genetics play a significant role in the chances of developing Type1 Diabetes (T1DM), yielding a risk of 240% depending on the first degree relative (FDR) affected. T1DM is a self-managed condition in which education and patient/carer engagement are key. We had noted cases of poor engagement and glycaemic control in our patients with a FDR with T1DM but found a paucity of literature examining this relationship.
Methods: We conducted a retrospective, case-controlled study in spring 2019. Our study cohort of patients with one or more FDR with T1DM were matched by age, sex, insulin regimen, duration of diabetes and age at diagnosis. We collated data on clinical presentation, HbA1c, hospitalisations, insulin regimen and clinic attendance (including education clinic). Statistical analyses used Students t-test, MannWhitney U and Fishers exact test.
Results: We identified 25 patients (11F) with a FDR with T1DM, ˜12% of our patient population. Eleven had a parent, 12 at least one sibling and two both a parent and sibling affected. For the study and control cohorts: mean age at diagnosis was 8.12 (range 0.9215.92) and 9.26 (2.1715.67); mean duration of T1DM was 6.53 (1.2716.80) and 5.70 (0.5715.11) and mean deprivation decile was 3.80 and 3.71 respectively. There were no significant differences in these figures or insulin regimen between the two groups. At presentation, the study cohort had lower mean HbA1c (87.7, 110.5 mmol/mol; P=0.02). Although not statistically significant, fewer patients in the study cohort presented in DKA (13.6%, 31.6%; P=0.46) and a lower proportion had subsequent hospital admissions for DKA (25%, 37.5%; P=0.24). The study cohort had a higher mean HbA1c one year after diagnosis (65.2, 56.6 mmol/mol, P=0.02). Although not significant, the study group had poorer clinic (81.3%, 87.2%; P=0.17) and education clinic attendance (30.09%, 33.88%; P=0.60).
Discussion: Our patients with a FDR with T1DM presented earlier but had a higher HbA1c a year after diagnosis with a trend to lower levels of engagement with the diabetes team, highlighting the need for healthcare professionals to guard against complacency and ensure appropriate support and education for patients with a FDR with T1DM.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes