Close intervention sessions complement intensive insulin therapy in paediatric diabetes: a longitudinal study

• Published in: Archives of disease in childhood 2023-10, Vol.108 (10), p.818-823
• Main Authors: Foran, Jason, Egan, Aisling, Somers, Eric, O'Connell, Susan M
• Format: Article
• Language: English
• Subjects: Age; Children & youth; Childrens health; Diabetes; Diabetes mellitus; Education; Hemoglobin; Infusion pumps; Insulin; Interdisciplinary Approach; Longitudinal studies; Nurse specialists; Original Research; Patients; Pediatrics; Socioeconomic factors; Socioeconomics; Variables
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2023-325436

To examine the impact of multidisciplinary team input and intensive insulin therapy on glycaemic control in children and adolescents with diabetes over a 13-year period. Two statistical approaches were used to interrogate the dataset. First a matched pair analysis to compare insulin treatment-type effect (pump vs multiple daily injections (MDIs)), followed by panel data regression to assess the impact of intensive re-education on glycated haemoglobin (HbA1c), in addition to treatment type. A large tertiary paediatric diabetes centre using a prospectively maintained database of clinical encounters from 2007 to 2020. Difference in HbA1c between treatment types (matching methodology) and expected change in HbA1c with treatment type and re-education (panel data). Compared with MDI, matched pump patients had a lower HbA1c 6 months after pump commencement (ΔHbA1c=-0.53%, CI -0.34% to -0.72%; n=106). This effect was robust in controlling for socioeconomic deprivation (ΔHbA1c=-0.74%, CI -0.40% to -1.08%; n=29). Panel data analysis demonstrated a -0.55% reduction in HbA1c with pump therapy compared with MDI therapy (CI -0.43% to -0.67%). Patients who had intensive re-education had recorded an HbA1c of 0.95% (CI 0.85% to 1.05%) greater than otherwise identical patients prior to re-education. Following these sessions, HbA1c dropped by a mean -0.81% (CI -0.68% to -0.95%) within 6 months. These were also robust in controlling for socioeconomic factors. Compared with matched peers on MDI regimens, patients on pump therapy have lower expected HbA1c, an effect sustained for up to 8 years. Intensive re-education is associated with a significant drop in previously elevated HbA1c levels.