In a new study published in the online-journal Pediatric Diabetes, researchers noted “markedly different diabetes self-management techniques” between children with excellent glycemic control and their poor-glycemic counterparts.
The study, which was co-authored by Desmond Schatz, MD and Michael Haller, MD of the UF Health Diabetes Center of Excellence, analyzed A1c level readings and questionnaire responses of 3272 individuals between the ages of 6 and 17 enrolled in the type 1 diabetes (T1D) Exchange Clinic Registry between 2010 and 2012.
The T1D Exchange clinic network is comprised of 67 U.S.-based pediatric and adult endocrinology practices. It forges a unique collaboration where data can be integrated and shared among institutions in the hopes of creating an open-forum on the knowledge of type 1 diabetes and accelerates the path to finding a cure. In addition to A1c readings, the national exchange network also documents demographic, socioeconomic, clinical, and diabetes management characteristics of all enrolled T1D patients.
Following questionnaire and A1c level readings, approximately 588 of the participants were characterized as having “excellent” glycemic control, and included a slightly younger population, which tended to include the following cohort characteristics: non-Hispanic white, male, of normal weight, have shorter T1D duration, higher annual household income, higher parental education level, and private insurance.
Furthemore, participants in the excellent control group more frequently monitored blood glucose, checked their blood glucose prior to giving meal time insulin, gave insulin for daytime snacks, gave insulin in advance of starting a meal, varied insulin:carbohydrate ratios for meals, less frequently missed an insulin dose, and used a pump to deliver insulin.
Of those characteristics, four remained notably higher when compared across the entire pediatric age spectrum: 1) checking glucose levels more frequently, 2) using lower daily insulin doses, 3) injecting insulin prior to meal-eating, and 4) using insulin pump therapy. These may be of particular importance when evaluating patients with type 1 diabetes in the future.
This study supports the notion that tight glycemic control can safely be achieved in children with type 1 diabetes and may help further inform diabetes care providers and patients about specific characteristics and behaviors that can be augmented to potentially improve glycemic control; given the current reality that too many children and adolescents fail to achieve optimal control of their type 1 diabetes (by a ratio of 4:1).
Future studies will likely encompass individualized or demographic-specific strategies designed to target improvements in diabetes management characteristics in children with poor glycemic control.
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