Metabolic Control in Children and Adolescents with Insulin-Dependent Diabetes Mellitus at

Abstract

Objective: Preventing long-term diabetic complications requires good metabolic control, especially in type 1 diabetes mellitus (T1DM). We describe the metabolic control of T1DM and the factors affecting it among children and adolescents attending the Pediatric Clinic at King Abdul-Aziz University Hospital. Methods: A retrospective cross-sectional study was conducted on T1DM children and adolescents who had attended the Pediatric Clinic at King Abdul-Aziz University Hospital from 2006 to 2010. Both clinical and laboratory data were reviewed for the enrolled cases. The mean age of the patients was 12.5±4.1 years. Ages ranged from 1 to 18 years (n=484: male=213, female= 271). 38.6% of the patients were pre-pubertal and 61.4% - pubertal. The patients were categorized into 3 age groups as 1-6 years (10.3%), 7-12 years (33.5%) and 13-18 years (56.2%). Results: The overall mean HbA1c was 9.4±2.4% and the duration of patient follow-up was 26±17 months. 10.3% of the patients were on conventional insulin regimens and 89.7% - on intensive insulin therapy. 31.4% had satisfactory HbA1c according to the American Diabetes Association guidelines. The duration of T1DM was 2.9±1.4 years. The patients with diabetes duration ≤2 years (45%) had a mean HbA1c of 8.7±1.8% and those with diabetes duration >2 years (55%) had a mean HbA1c value of 9.8±2.3% (p< 0.001). Conclusions: The metabolic control of T1DM children in our cohort was less satisfactory than in other studies. We recommend the promotion of physical exercise and family educational programs to improve the metabolic control of T1DM pediatric patients in our population.Conflict of interest:None declared.

Effectiveness of Multiple Daily Injections or Continuous Subcutaneous Insulin Infusion for Children with Type 1 Diabetes Mellitus in Clinical Practice

“…In other words, SMBG frequency did not increase with the number of injections among patients in group 2A. The refusal of adolescent patients to increase monitoring frequency, as well as their reluctance to follow a strict diet and exercise more frequently, is commonly encountered in clinical practice [ 4 , 7 , 11 , 12 ]. We thus believe that the lack of good disease management caused poor glycemic control after 6 months of MDIs/CSII therapy.…”

“…The Diabetes Control and Complications Trial (DCCT) and the follow-up Epidemiology of Diabetes Intervention and Complications Study (EDIC) confirmed that intensive insulin treatment could improve glycemic control, reducing or delaying the long-term complications of T1DM, with a persistent benefit [ 1 – 3 ]. Since these results were published, intensive insulin therapy has been widely applied in clinical practice, almost becoming the standard of care [ 4 – 6 ]. However, in contrast to the DCCT and EDIC findings, Holl et al [ 7 ] found that the use of intensive therapy did not improve glucose control in clinical practice in 17 European countries.…”

Can mHealth, when monitored by a primary care provider, maintain hemoglobin A1c values in target range with adolescents between the ages of 10-19 diagnosed with type 1 diabetes mellitus?

“…In the adolescent population, poor glycemic control, changing physiology, and behavioural and adherence issues can be causative factors in acute and chronic complications of T1DM (Al-Agha, Ocheltree, & Hakeem, 2011). However, daily self-monitoring of blood glucose, daily insulin injections, regular hemoglobin A1c (HgbA1c) measurements, and close monitoring of physical activity can aid in the reduction of T1DM-associated complications (Al-Agha et al, 2011;CDACPGEC, 2013).…”