Assessment and monitoring of glycemic control in children and adolescents with diabetes

Glycemic Control Rate in Patients With Type 1 Diabetes Treated at a Public Tertiary Referral Hospital in Rio de Janeiro, Brazil

“…Regarding US data, where approximately 60% of the studied population were using insulin pump, considered to be the gold standard therapy for T1D, the control rate was 17-23% in patients younger than 18 years old, 14% in subjects aged 18 -25 years old, and about 30% among adults over 25 years old, with a mean HbA1c of 8.2-9.0%, 8.7% and 7.6-7.7%, respectively [20]. In our study, only 22.14% of the patients (21.74% individuals ≤ 18 years old and 22.53% adults > 18 years old) reached the recommended goal, which is in agreement with that reported in the literature [5,10,20,21]. A greater number of consultations per year also did not imply in a better glycemic control.…”

“…In our study, most of the patients (46.21%) had ≥ 4 tests per day, while a minority (9.85%) less than once a day, even though patients have access to inputs required to perform at least three tests daily. Several studies have demonstrated a strong correlation between SMBG frequency and glycemic control [15,19,21,[36][37][38][39], which was not observed in our study. A database study of almost 27,000 children and adolescents with T1D showed that increased daily frequency of SMBG was significantly associated with lower HbA1C (-0.2% for one additional test per day) and with fewer acute complications [36].…”

“…In the DCCT, for example, the intensively treated adolescent cohort achieved a mean HbA1c of 8.06%, whereas subjects in the corresponding adult cohort achieved a mean HbA1c of 7.1% [11]. In our study, this difference could be explained by the fact that our study gathered mostly adolescents (65% of them during puberty), which, of all age groups, are currently the farthest from achieving target HbA1c lower than 7.5% [21,22]. Lack of concern regarding their disease, as well as psychological and hormonal changes can partially explain poor diabetes management during puberty.…”

“…Regarding SMBG, the optimal frequency in patients with T1D is unclear but ADA and ISPAD recommend that SMBG should be performed usually 4 -6 times a day [15,21]. In our study, most of the patients (46.21%) had ≥ 4 tests per day, while a minority (9.85%) less than once a day, even though patients have access to inputs required to perform at least three tests daily.…”

Being mothers and fathers of a child with type 1 diabetes aged 1 to 7 years: a phenomenological study of parents’ experiences

“…Among a totality of 329 children diagnosed with diabetes in Norway in 2016, the incidence of children < 5 years of age was 68. The main goals of diabetes treatment among children with T1D are to achieve the best feasible blood glucose concentrations, to minimise the occurrence of hypoglycaemic events, and to prevent long-term complications (Rewers et al, 2014). Thus, the treatment of children with T1D requires multiple medical decisions and technical procedures related to blood glucose monitoring and insulin administration, every day.…”