Endocrine Abstracts

Introduction: National guidance recommends Level 3 carbohydrate counting (L3CC) is delivered within 2 weeks of diagnosis of Type I Diabetes Mellitus (T1DM) (NICE, 2015). This was introduced at Derbyshire Children’s Hospital in 2017. This service evaluation aimed to assess the impact of this on patients’ blood glucose, by recording HbA1c levels at quarterly intervals over 6 months.

Methods: A comparison of quarterly HbA1c in children that received L3CC at diagnosis were compared to a historical control group of those that did not, being diagnosed prior to the implementation of L3CC. HbA1c results were taken during attendance at multidisciplinary clinics. Where exact quarterly dates were not available, the closest time period either side was taken.

Results: HbA1c readings for 89 children (45 females, 44 males; mean age 9.5years) were included, 48 children received the intervention and 41 did not. The mean HbA1c at diagnosis were similar (105 mmol/mol and 97 mmol/mol for the control and intervention groups respectively; P=0.06). HbA1c reduced by 46% in both groups after 3 months and was significantly lower in the intervention group (56 mmol/mol vs 52 mmol/mol respectively; P=0.008). HbA1c remained significantly lower in the intervention group at 6 months (56 mmol/mol vs 48 mmol/mol; P=0.001).

Conclusion: Introduction of L3CC within 2 weeks of diagnosis of T1DM in children has beneficial effects on glycaemic control at 3 and 6 months post diagnosis compared with traditional care. HbA1c was significantly lower following L3CC, and children reached the target HbA1c of 48 mmol/mol, which minimises their risk of long term complications (NICE, 2015).