Endocrine Abstracts

Introduction: Pre-school children with Type 1 Diabetes are a vulnerable group of patients, presenting both diagnostic and management challenges which can place them at increased risk of worse glycaemic control and the complications of Diabetes. The use of advancing diabetes-related technologies including continuous glucose monitoring (CGM) and Hybrid-closed loop (HCL) systems offers the real potential to improve outcomes.

Aim: To conduct a countywide review of pre-school children newly diagnosed with Type 1 Diabetes, evaluating clinical presentation, management and outcomes including HbA1c.

Method: Children aged 0–4-years and newly diagnosed with Type 1 Diabetes between 1st April 2020 and 1st January 2023 were identified using the countywide Diabetes patient database. Clinical notes were retrospectively reviewed.

Results: Twenty-two children aged between nine months and four years eight months were identified. Seventeen (77.3%) children presented in DKA, with seven (41.2%) classified as severe; six (35.3%) moderate and four (23.5%) mild. Preceding diagnosis, eight children (36.4%) had either attempted to, or had seen a healthcare professional, increasing to 41.1% amongst those presenting in DKA. Once commenced on subcutaneous insulin, it took a mean of 41.86 (S.D. 59.35) days for children to start using insulin to carbohydrate ratios and only seven (31.8%) started within fourteen days. All patients had been commenced on a CGM device (flash or real-time), with the average time to CGM improving significantly between 2020–21 and 2021–22, although there still exists a delay. Thirteen (59.1%) children had commenced pump therapy, taking a mean of 429.38 days from diagnosis. This cohort demonstrated an improvement in mean HbA1c from 97.12 mmol/mol (seventeen patients) at diagnosis to 67 mmol/mol (fourteen patients) at twelve months. However, this improvement of 30.12 mmol/mol (95% CI 17.64–42.6, P=0.0001) remains sub-optimal.

Conclusion: This review identifies the need for enhanced education and awareness of the risk of T1D in pre-school children after three-quarters presented with Diabetic Ketoacidosis (DKA). Results also indicate that outcomes are sub-optimal and pump therapy is being under-utilised in this patient group. Early introduction of HCL systems should be considered.