Management of type 1 diabetes and HbA1c audit

Khine Wut Yee Kyaw; Allison Grove; Victoria Hemming

doi:10.1530/endoabs.95.P17

Background: There is clear evidence that achieving optimal glycaemic control in type 1diabetes reduces the complications of diabetes. Increased technology use is associated with lower HbA1c. NICE target HbA1c is 48 mmol/mmol.

Objective: Are there differences in HbA1c between patients with Type 1 diabetes using continuous glucose monitoring sensor (CGM) or hybrid closed loops in real world setting in paediatric patients at Mid Yorkshire Teaching NHS Trust?

Method: Compare the most recent HbA1c in September 2022 with HbA1c from 2021 for 313 of patients with Type 1 diabetes aged 0–18 years under the MY Paediatric diabetes service.

Results: 57% of patients were on injections, 21% on pump and 22% on pump with closed loop. For glucose monitoring, 55% use CGM, 37% Libre and 7% use finger prick glucose testing. We found that HbA1c improved with CGM across all age groups (by up to 10%). The biggest reduction in HbA1c was seen in groups using injections with CGM and those with using hybrid closed loop system.

Table 1 HbA1c improvement after using continuous glucose monitoring
	Mean HbA1c (mmol/mmol)
Age (yr)	Baseline	End-point	Difference	Improvement
<5	81.86	62.29	19.57	23.91%
5–9	71.08	58.76	12.32	17.33%
10–14	74.68	63.58	11.10	14.86%
15–19	72.58	67.02	5.56	7.66%
Total	73.24	64.02	9.23	12.60%

Table 2 Median HbA1c difference among different groups
	Baseline	End-point	Difference	Improvement
Group 1 – Insulin Injection	62	65	−3	−4.03%
Group 2 – Injection + libre	69	65	4	5.11%
Group 3 – Injection + CGMS	71	64	7	9.22%
Group 4 – Pump + Libre	64	60	4	6.30%
Group 5 – Pump + CGMS (without Closed-Loop)	60	56	4	6.67%
Closed-Loop	62	57	5	8.06%

Conclusion: CGM and hybrid closed loop systems improve HbA1c. Following updates to local commissioning policy in line with NICE guidance on use of CGM all children and young people under the care of MY Paediatric Diabetes service will be encouraged to use CGM. We await the NICE Technology Appraisal on hybrid closed loop systems.HbA1c improvement after using continuous glucose monitoringMedian HbA1c difference among different groups

Endocrine Abstracts

P17