Endocrine Abstracts

Introduction: Achieving glycaemic targets for young children with type 1 diabetes (T1D) is challenging due to rapidly changing physiology and behavioural patterns. An under-fives specialised multidisciplinary clinic (U5-MDT) was implemented in January 2022 due to poorer glycaemic control in this group compared to the rest of the clinic cohort. The U5-MDT aimed to optimise glycaemic control through access to technology while providing family support.

Methodology: Evaluation of all children under five years with T1D who had been diagnosed at least one year (out of honeymoon) before their first U5-MDT. Descriptive data was collected and reported by percentage or mean (± standard deviation) on socioeconomic status (SES, 1–5 quintiles, 1= most deprived), age at diagnosis, gender, duration of diabetes at final reporting, interpreter required, and diabetes therapy from the electronic patient record system. We compared one month of glycaemic control a year after diagnosis to the glycaemic control for one month using their latest download (collected July 2023), which was at least six months after the first U5-MDT by paired t-test (two-tailed, P<0.05). Outcome measures were time below range (<3.9 mmol/L), time in range (3.9 – 10.0 mmol/L), and time above range (>10.0 mmol/L).

Results: 12 children (five male) mean age at diagnosis of 2.3 years (±1.5) with a T1D duration of 2.5 years (±1.2) at final data collection were evaluated. A quarter of families required an interpreter, and 75.0% (national average 23.7%) were from the most deprived SES quintile. All children used continuous glucose monitoring before the U5-MDT clinic started, with only two using an automated insulin delivery system (AID). By July 2023, 10 of 12 were using an AID. Before U5-MDT vs. after U5-MDT, the change outcome measures were; TBR 2.8% (±1.9) vs. 2.5% (±1.2) [0.3% (95% CI −0.9 to 1.5), P=0.3], TIR 41.6% (±17.8) vs. 58.8% (±12.3) [−17.3% (95% CI −30.8 to −3.7), P<0.05], TAR 55.5% (±12.3) vs. 37.1% (±13.4) [18.3% (95% CI 4.0 to 32.7), P<0.05].

Conclusion: A dedicated U5-MDT allows better support and quicker access to AID, improving glycaemic outcomes. Hence, we suggest initiating targeted under-fives clinic prioritising technology and support.