Metabolic control of type 1 diabetic patients followed at the University Children's Hospital in Berne: have we reached the goal?

Abstract

Question under study: In type 1 diabetes (T1DM), a good metabolic control is important to reduce and/or postpone complications. Guidelines regarding how to achieve this goal are published by the American Diabetes Association (ADA) and the International Society of Paediatric and Adolescence Diabetes (ISPAD). The aims of this study were to determine the current level of metabolic control in T1DM patients on different treatment regimens, followed at the diabetes outpatient unit of the University Children's Hospital Bern, Switzerland, and to compare it with both the reported data from ten years ago (1998) and with the current guidelines of the ADA and ISPAD.

Methods: This was an observational, cross-sectional study and involved assessment of HbA1c levels as a surrogate marker of the metabolic control in all patients seen during a regular four month interval at our outpatient clinic.

Results: A total of 152 patients (88m, 64f) were recorded. 43.4% (n = 66) were conventionally treated (insulin: twice-daily, three-dose treatment), whereas 56.6% (n = 86) were on a multiple injection treatment (e.g. functional insulin treatment and/or insulin pump). Actual overall HbA1c values, expressed as medians (25th/75th centiles), were 7.6% (7.0/8.3) compared to 7.9% (7.3/8.6) in 1998 (p <0.01). In younger, prepubertal children the HbA1c value recorded was 7.4% (6.9/8.1), and 7.7% (7.2/8.5) in adolescents. Interestingly, no significant difference was observed between HbA1c levels of conventionally versus intensively treated patients.

Conclusions: With current treatment strategies, glycaemic control of T1DM children and adolescents improved significantly (p <0.01) between 1998 and 2008, although only a minority of the subjects reached the ISPAD goals.