The influence of an educational program on the HbA1c-level of adolescents with type 1 diabetes mellitus: a retrospective study

Abstract Objectives The development of continuous glucose monitoring (CGM) systems has allowed for identification of blood sugar variations and trends in real-time that is not feasible with conventional self-monitoring of blood glucose. However, there is inconsistent data to show that the use of CGM leads to better glycemic control as measured by Hemoglobin A1c (HbA1c) in pediatric patients with type 1 diabetes mellitus. Our study aimed to compare the average HbA1c level in the 1–2 years prior to starting a CGM to the average HbA1c level in the 1–2 years immediately following CGM initiation in a sample of 1–20 year olds with type 1 diabetes mellitus. Methods Participants were 90 youth (ages 1–20) followed for type 1 diabetes care at our institution who used a CGM for at least a 6 month time period. We performed a retrospective chart review to obtain up to four HbA1c values pre and post-CGM initiation each. We evaluated pre- and post-CGM initiation changes in mean HbA1c via dependent samples t-tests using IBM SPSS 24.0. Results The mean HbA1c was 8.7% pre-CGM and decreased to 8.27% 9–12 months after CGM initiation in the overall sample. A statistically significant decrease in HbA1c was seen in patients who used multiple daily injections (p=0.02), those with a pre-CGM HbA1c greater than 9% (p=0.01), and those with a diabetes duration of 5–10 years (p=0.02). Conclusion CGM use was associated with a decrease in HbA1c over time which was statistically significant in some subgroups.

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Evaluation of Microalbuminuria and Glycosylated Hemoglobin in the Assessment of Diabetes Control in Children with Type 1 Diabetes Mellitus Hospitalized with Diabetic Ketoacidosis

Journal of Comprehensive Pediatrics ◽

10.5812/compreped.109904 ◽

2021 ◽

Vol 12 (2) ◽

Author(s):

Saiprasad Onkareshwar Kavthekar ◽

Vijay Tukaram Mali ◽

Sachin Verma ◽

Anil Bapurao Kurane ◽

Nivedita Balasaheb Patil ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Diabetic Nephropathy ◽

Glycemic Control ◽

Type 1 Diabetes Mellitus ◽

Hba1c Level ◽

Glycosylated Hemoglobin ◽

Duration Of Diabetes ◽

Hba1c Control

Background: Microalbuminuria is thought to be an early predictor of impending diabetic nephropathy, while glycosylated hemoglobin (HbA1c) is a biochemical marker of long-term glycemic control in children with type 1 diabetes mellitus (T1DM). Objectives: The study aimed to evaluate the prevalence of microalbuminuria and its association with HbA1c on admission and duration of diabetes. Also, changes in HbA1c level on admission and three months after admission were studied to assess diabetes control in children with T1DM. Methods: This prospective study was conducted among 38 children (< 18 years) diagnosed with TIDM presenting with clinical signs, symptoms, and biochemical parameters of DKA. The presence of microalbuminuria, HbA1c level, and the number of past episodes of DKA were recorded. HbA1c level was again estimated after three months. The resultant data was tabulated and analyzed statistically (P < 0.05). Results: Microalbuminuria and poor HbA1c control were observed in 18% and 60% of the sample population, respectively. A significant association was found between HbA1c > 9% (P = 0.032) and the duration of diabetes > 4 years (P = 0.032) and microalbuminuria. Significant improvement in glycemic control was noted from the time of admission to three months after admission (9.76 ± 2.77 vs. 7.75 ± 1.28; P = 0.00012). A significant difference was observed between past DKA episodes according to HbA1c control (P < 0.001). Conclusions: Microalbuminuria assessment is needed in T1DM children, especially those with HbA1c > 9% and duration of diabetes > four years, to evaluate diabetic nephropathy. Good glycemic control can be achieved with effective insulin therapy accompanied by appropriate counseling and regular follow-up.

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The fifty two week study of the effectiveness and safety of Apidra insulin therapy in combination with Lantus insulin in the children and adolescents with type 1 diabetes mellitus and poor glycemic control

Problems of Endocrinology ◽

10.14341/probl201460621-28 ◽

2014 ◽

Vol 60 (6) ◽

pp. 21-28

Author(s):

Valentina A Peterkova ◽

Tamara L Kuraeva ◽

Elena A Andrianova ◽

Elena V Titovich ◽

Galina N Svetlova ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Blood Glucose ◽

Blood Glucose Level ◽

Type 1 Diabetes Mellitus ◽

Glucose Level ◽

Hba1c Level ◽

Age Group ◽

Insulin Glargin

The present multi-center non-randomized open prospective phase IV study was carried out based at 8 clinical centers of the Russian Federation. It included 89 patients at the age from 6 to 17 years suffering from type 1 diabetes mellitus during a period over 1 year. The children treated with Lantus (insulin glargin) in combination with any short-acting insulin in accordance with the basal-bolus regime and having the HbA1c level from=>8% to =<10% were transferred to Apidra (insulin glulisine) therapy in combination with Lantus insulin. The number of patients in the first age group (6-12 years) having the HbA1c level <8% within 12 months after the onset of therapy was 51.1%. However, only 31.1% of them, did not experience episodes of symptomatic hypoglycemia during this period with the blood glucose level =< 3.1 mmol/l. In the age group 2 (13-17 years), 31.1% of the patients reached the target HbA1c level <7.5% during the 12 month treatment period, but only 13.3% had no episodes of symptomatic hypoglycemia of =<3.1 mmol/l during this period. The HbA1c level in groups 1 and 2 decreased from 8.75±0.6 to 8.05 ±1.06% (p=0.046658) and from 8.77±0.58 to 7.96±1.12% (p=0.017533) respectively. The requirements for insulin in either group did not significantly change throughout the study period. A total of 1866 hypoglycemic episodes were recorded (i.e. 20.73 episodes per patient) including 90.8% of daytime and 9.2% of nocturnal hypoglycemia; symptomatic hypoglycemia accounted for 98.8% of all the cases and asymptomatic one for 1.2%. Fifty three (0.35%) cases were interpreted as severe hypoglycemia (blood glucose level ≤2 mmol/l), five (0.27%) patients had to be hospitalized . Hypoglycemic episodes were not documented in 13 children.

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