Endocrine Abstracts

Background: The need for improved glycaemic control in children with type 1 diabetes in Scotland is well recognised; DIABAUD 3 identified that only 9.7% achieved the national HbA1c target.

Aim: To evaluate whether a change from three times daily injection regimen to a basal bolus regimen with carbohydrate counting at diagnosis will result in an improvement in immediate and longer term glycaemic control.

Method: We included children <16 years of age admitted to Royal Hospital for Sick Children, Edinburgh with a new diagnosis of non-decompensated type 1 diabetes Mellitus. A retrospective case note review was performed for children admitted before August 2010 (n=36) started on three times daily injections and a prospective case note review for children admitted after August 2010 (n=36) started on basal bolus regimen. Data collected consisted of HbA1c and initial blood glucose and blood ketone results, as well as HbA1c values at 6 and 12 months follow up.

Results: Children on the basal bolus regimen showed better control in the last 24 h before discharge, with 37% of readings under 10 mmol/l vs 30.5% on the previous regimen. HbA1c was measured at diagnosis, 6 and 12 months. At 6 months after diagnosis mean HbA1c had decreased further in children commenced on basal bolus regimen, compared with children commenced on the standard regimen (44.7 vs 36.6%, P<0.05). This was despite the fact that 25/36 of those originally commenced on the standard regimen subsequently switched to a basal bolus during the follow up period.

Conclusion: In the Lothian population children started on a basal bolus regimen at diagnosis showed better glycaemic control during admission and at 6 months post diagnosis. Data collection is ongoing for HbA1c results at 12 months. The reasons for this improved glycaemic control may be mutifactorial and further studies are required.