Endocrine Abstracts

Background: Type 1 diabetes mellitus is an autoimmune condition resulting in insulin deficiency, causing both long and short term complications. The Diabetes Control and Complications Trial (DCCT) demonstrated that tight glycaemic control and consequent lower HbA1c values reduced the risk of long-term complications. This can be achieved using multiple daily injections (MDI) or newer continuous subcutaneous insulin infusion (CSII) therapy. This is recommended by NICE for those over 12 years with T1DM who are unable to reach their target HbA1c level with MDI without experiencing disabling hypoglycaemic episodes. In children under, 12 if MDI is inappropriate or not practical, CSII is also recommended.

Objective and hypotheses: The objective of this study was to discover whether CSII had a significant impact on the HbA1c of the children at St Peter’s Hospital (SPH) and to determine what other parameters should be measured in these children.

Method: HbA1c levels and number of hypoglycaemic episodes before and after starting CSII were analysed from the children’s annual review data of 56 patients at SPH. The HbA1c averages before and after implementation of CSII were taken.

Results: Of the 56 children on CSII at SPH, 47 had data that could be analysed. HbA1c decreased from an average of 8.86 (73.3 mmol/mol) before starting CSII to 7.97 (63.6 mmol/mol) afterwards (P=0.0001). The percentage of children reaching their target HbA1c increased from 2.13 to 27.66%. Disabling hypoglycaemic episodes were not reliably recorded at the annual reviews.

Conclusion: There was a statistically significant improvement in HbA1c when children were switched to CSII, supporting its use in this population. It was not determined whether the number of disabling hypoglycaemic episodes reduced, or whether quality of life improved. We recommend that these should be monitored as part of the annual review.