Young children with type 1 diabetes can achieve glycemic targets without hypoglycemia: Results of a novel intensive diabetes management program

Abstract

Background: Young children with type 1 diabetes (T1D) present unique challenges for intensive diabetes management. We describe an intensive diabetes program adapted for young children and compare glycemic control, anthropometry, dietary practices and insulin regimens before and after implementation.

Methods: Cross sectional data from children with T1D aged ≥0.5 to <7.0 years attending the John Hunter Children's Hospital (JHCH), Australia in 2004, 2010 and 2016 were compared. Outcome measures were glycemic control assessed by hemoglobin A_1c (HbA_1c ); severe hypoglycemia episodes; body mass index standard deviation scores (BMI-SDS); diabetes ketoacidosis (DKA) episodes; and insulin regimen-twice daily injections, multiple daily injections, or continuous subcutaneous insulin infusion.

Results: Mean HbA_1c declined by 12 mmol/mol over the study period (P < .01). The proportion of children achieving a mean HbA_1c < 58 mmol/mol increased significantly from 31% in 2004 to 64% in 2010 (P < .01), and from 64% in 2010 to 83% in 2016 (P = .04). The mean BMI-SDS was significantly lower in 2010 when compared with 2004 (P<.01); however, this trend plateaued between 2010 and 2016 (P = .97). Severe hypoglycemia and DKA occurred infrequently. The prevalence of overweight or obesity increased from 2010 to 2016 (P = .03).

Conclusions: The JHCH intensive diabetes management program has resulted in 83% of young children in 2016 achieving target glycemia without an increase in severe hypoglycemia or DKA. Overweight remains a challenge in this population warranting action to reduce weight and protect these children from future obesity-related health risks.

Keywords: child; continuous subcutaneous insulin infusion; multiple daily injection therapy; preschool; type 1 diabetes.