Our large tertiary hospital-based diabetes service high HbA1c policy selects Children and Young People (CYP) with HbA1c above 64 mmol/mol for additional support. Two-week average blood glucose (ABG) is utilised in the high HbA1c clinic as a proxy for HbA1c and CYP are encouraged to reduce their 2 week ABG as a primary goal.
Aims: To determine the relationship between HbA1c, 2 week and 3 month ABG and standard deviation (S.D.) in CYP with Type 1 Diabetes (T1DM) in our cohort and to identify related factors with the potential to improve control.
Method: Diasend downloads between 1/11/17 to 31/8/18 related to clinic visits were analysed for 1 in 3 randomly selected patients with T1DM greater than 12 months duration, aged 118 years, for correlation of 2 week and 3-month ABG, S.D., test frequency and bolus advisor use with clinic visit HbA1c and therapy.
Results: 95 randomly selected downloads of 349 CYP with T1DM were analysed. Bolus calculators were used by 85 (89%) with 53/85 (62%) entering at least 3 carbohydrate containing meals or snacks per day and 31/95 (33%) using CSII. Correlation with HbA1c was greater for 3 month ABG vs 2 week ABG (R=0.58 vs 0.44) and for patients performing 5 or more tests per day (R=0.78 vs 0.46). Blood glucose S.D. < 4 mmol, achieved by 22/95 (23%), was significantly associated with both improved HbA1c 51.9 vs 68.3 mmol/mol (P<0.00001) and lower 3 month average BG.
Discussion: Our unit will continue to specify that reviewing and reducing the 2 week ABG is the short term interval goal to facilitate improved control. However, CYP will be informed the 3 month ABG is more representative of the HbA1c to be expected in clinic, to avoid disappointment, and predictive accuracy of ABG is improved when at least 5 BG tests are taken each day. The team will focus on strategies to educate and support CYP to understand and reduce the blood glucose S.D. to below 4 mmol/l as a means to further improve control and outcomes.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes