Endocrine Abstracts

Background: The impact of HbA1c on the long-term complications of type 1 diabetes (T1DM) is well documented. A strategy to support these patients is an elective admission for diabetes education and stabilisation. However, this strategy has implications for school attendance, is disruptive for families, and requires valuable medical beds. We therefore sought to evaluate the effectiveness of an elective “admission for stabilisation” on HbA1c levels.

Methods: We reviewed the notes of every child/young person with an elective admission for diabetes education/stabilisation from March 2022 to March 2024 (twelve admissions for nine patients). We reviewed HbA1c measurements before the admission, and at both 2-6 and 12-18 months after the admission. We reviewed the interventions that had taken place during the admission. We also looked for diabetic ketoacidosis (DKA) episodes before and after the elective admission.

Results: Six patients had one admission and three patients were admitted twice. Of the six patients admitted once, all had a significant reduction in HbA1c at 2-6 months (-4 mmol/mol to –29 mmol/mol, mean –18 mmol/mol). After one year (data available for four patients), HbA1c changes ranged from – 22 mmol/mol to + 2 mmol/mol (mean –11 mmol/mol). Of patients admitted twice, two had significant reductions in HbA1c six months after the second admission (-20 mmol/mol, -31 mmol/mol) and one’s HbA1c has steadily increased to >130 mmol/mol. Three patients were referred to social services during their admission and two for mental health support. Of two patients subsequently subjected to a Child Protection Plan, one had a significant decrease in HbA1c (-20 mmol/mol) and one an increase (HbA1c >130 mmol/mol). Three patients commenced a hybrid-closed loop system with one sustained decrease in HbA1c (-22 mmol/mol), one unchanged (+2 mmol/mol), and one increase (HbA1c >130 mmol/mol). Of nine patients, five had DKA prior to admission with one to five episodes per patient. Only one patient has so far experienced DKA after admission.

Conclusion: Our local study suggests that admission for education and stabilisation of T1DM patients leads to a sustained reduction in HbA1c and reduces the risk of DKA. These promising findings encourage the continued use of elective admission for education/stabilisation as a management strategy.