Endocrine Abstracts

Introduction: Achieving an HbA_1c of less than 48 mmol/mol minimises the risk of complications in children and young people with type one diabetes. Elective admissions to hospital are one option employed to improve glycaemic control in patients with an HbA_1c above target. There is however limited evidence to support such admissions. We aimed to retrospectively compare glycaemic control between patients electively admitted to hospital to stabilise their diabetes with a matched control group.

Methodology: Records of all children and young people with type one diabetes, admitted for the purpose of stabilisation of poor glycaemic control over a one-year period at our centre were reviewed. Admitted patients were matched with a control patient receiving support in the community, based on sex, age and HbA_1c. Measures of HbA_1c, average blood glucose and number of blood glucose tests at admission, were compared to values at three, six and twelve months after admission using t-tests.

Results: Twelve children (mean age 13.1years) were electively admitted for diabetes stabilisation during the study period. The control group did not differ in baseline demographics to those admitted. Mean HbA_1c of the admitted group decreased from 84.8 mmol/mol to 76.8 mmol/mol twelve months after admission, this was a similar improvement to the control group (HbA_1c decreased from 80.4 mmol/mol to 69.0 mmol/mol, P=0.80). Admitted patients and controls demonstrated similar changes in mean blood glucose (admitted -1.82 mmol/l vs controls -1.28 mmol/l, P=0.74) and number of blood glucose checks (admitted -0.44 vs controls -0.73, P=0.92) twelve months after admission. When stratified by HbA_1c, those with HbA_1c≥80 mmol/mol demonstrated a trend towards a greater improvement in HbA1c at twelve months than those with HbA_1c<80 mmol/mol (-18.8 mmol/mol vs +2.7 mmol/mol, P=0.29). Stratification by sex, showed females had a greater improvement in HbA_1c twelve months after admission than males (-23.4 mmol/mol vs +13.4 mmol/mol, P=0.05).

Conclusion: Elective admissions appear to lead to a modest improvement in HbA_1c one year after admission, however this is similar to the improvements seen in non-admitted patients with comparably poor glycaemic control. Admissions may be more beneficial to specific strata of the population, highlighting the need for careful selection of patients for diabetes stabilisation admissions.