Abstract
In type 1 diabetes (T1DM), a good metabolic control is important to reduce and/or postpone complications. Guidelines regarding how to achieve this goal are published by the American Diabetes Association (ADA) and the International Society of Paediatric and Adolescence Diabetes (ISPAD). The aims of this study were to determine the current level of metabolic control in T1DM patients on different treatment regimens, followed at the diabetes outpatient unit of the University Children's Hospital Bern, Switzerland, and to compare it with both the reported data from ten years ago (1998) and with the current guidelines of the ADA and ISPAD. This was an observational, cross-sectional study and involved assessment of HbA1c levels as a surrogate marker of the metabolic control in all patients seen during a regular four month interval at our outpatient clinic. A total of 152 patients (88m, 64f) were recorded. 43.4% (n = 66) were conventionally treated (insulin: twice-daily, three-dose treatment), whereas 56.6% (n = 86) were on a multiple injection treatment (e.g. functional insulin treatment and/or insulin pump). Actual overall HbA1c values, expressed as medians (25th/75th centiles), were 7.6% (7.0/8.3) compared to 7.9% (7.3/8.6) in 1998 (p <0.01). In younger, prepubertal children the HbA1c value recorded was 7.4% (6.9/8.1), and 7.7% (7.2/8.5) in adolescents. Interestingly, no significant difference was observed between HbA1c levels of conventionally versus intensively treated patients. With current treatment strategies, glycaemic control of T1DM children and adolescents improved significantly (p <0.01) between 1998 and 2008, although only a minority of the subjects reached the ISPAD goals.
Highlights
Taking care of chronically ill patients, in particular with type 1 diabetes mellitus (T1DM), is a major challenge in paediatrics
To prevent longterm complications, such as retinopathy, nephropathy as well as neuropathy for example, the best possible metabolic control in both children and adults with T1DM is crucial. Underlining these facts, the Diabetes Control and Complications Trial (DCCT) in 1993 followed by the Epidemiology of Diabetes Interventions and Complications (EDIC) study in 2003 unambiguously showed that improving glycaemic control in a population of 13–39 year old T1DM subjects reduced the risk for microvascular complications [4, 5]
This can be achieved by daily self-monitoring of blood glucose (SMBG) and by regular measurements of glycated haemoglobin (HbA1c), which has a strong predictive value for diabetic complications [10]
Summary
Taking care of chronically ill patients, in particular with type 1 diabetes mellitus (T1DM), is a major challenge in paediatrics This is of great importance as 50% of subjects with T1DM are diagnosed within the first 15 years of life and three quarters of all cases are found in individuals younger than 18 years of age [1]. To prevent longterm complications, such as retinopathy, nephropathy as well as neuropathy for example, the best possible metabolic control in both children and adults with T1DM is crucial Underlining these facts, the Diabetes Control and Complications Trial (DCCT) in 1993 followed by the Epidemiology of Diabetes Interventions and Complications (EDIC) study in 2003 unambiguously showed that improving glycaemic control in a population of 13–39 year old T1DM subjects reduced the risk for microvascular complications [4, 5]. According to the guidelines of the American Diabetes Association (ADA), treatment of T1DM should target a HbA1c of be-
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