Therapy Goal Achievement in Children and Adolescents with Type 1 Diabetes Mellitus in Insulin Pump Therapy Depending on the Glucose Monitoring and Educational Programs

Abstract

Background: Education and treatment programs can help children and adolescents with type 1 diabetes (T1D), and their parents, to independently carry out the necessary measures to achieve the treatment goals. In this regard, it seems extremely relevant to develop and evaluate the effectiveness of a training-modified program, considering national characteristics for children and adolescents with T1D who are devoted to using insulin pumps for insulin administration. The purpose of this work was to evaluate the effectiveness of a modified training program in achieving target levels of glycemia in children and adolescents with T1D on insulin pump therapy in Almaty. Methods and Results: Our study included 125 children and adolescents with T1D who were divided into 2 groups. The main group (MG), with a modified educational program, consisted of 68 children and adolescents with T1D who studied quarterly at the "School of T1D." The comparison group (CG) consisted of 57 children and adolescents with T1D who were on outpatient and inpatient treatment in different clinics and were trained in the "School of T1D" by the traditional method. All surveyed children and adolescents took a training course 2-3 times a year (each session 5 days long) from 2018 to 2021. The patients of MG and CG were divided into 2 subgroups depending on the method of assessing glycemia: self-monitoring blood glucose (SMBG) using an individual glucometer and FreeStyle Libre Glucose Sensor (FSLGS) for continuous glucose monitoring (CGM). The modified program included the installation of Flash monitoring and a strategy to increase time in the target range, as well as calculating the insulin bolus dose in bread units, calculated in national dishes, then monitoring treatment correction. After a year of training, the frequency of achieving target levels of HbA1c (≤7.0%) increased to 60.5% compared to 30.6% at the initial stage in the main subgroup with SMBG and 66.4% versus 28.7% in the main subgroup with the FSLGS for CGM; it was significant in both cases (P=0.01). In the comparison subgroups, achieving target levels of HbA1c was less pronounced and not significant (46.2% compared to 29.5% at the initial stage in the subgroup with SMBG and 51.1% compared to 29.1% at the initial stage in the subgroup with the FSLGS for CGM, P>0.05 in both cases). Conclusion: CGM and modified learning significantly contribute to the management of T1D, are associated with lower HbA1c levels and longer stay in the time-in-range, and increase the commitment of patients and their parents to the self-control of glucose.