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Achieving meaningful reduction of HgbA1c in pediatric type 1 diabetes requires an individualized approach
Andrew Kanouse1, Joanna S Fishbein2, Parissa Salemi1
1Division of Diabetes and Endocrinology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, USA.
Insights
Technological interventions like continuous glucose monitors (CGM) and insulin pumps, along with frequent clinic visits, can improve hemoglobin A1c (HgbA1c) in children with type 1 diabetes. However, individual patient needs necessitate tailored treatment plans for optimal HgbA1c management.
Area of Science:
- Pediatrics
- Endocrinology
- Metabolic Disorders
Background:
- Type 1 diabetes (T1D) management in children often involves challenges in achieving target hemoglobin A1c (HgbA1c) levels below 7.0%.
- Elevated HgbA1c levels (above 10%) significantly increase the risk of diabetes-related complications.
- Effective diabetes care integrates medication, education, and lifestyle modifications.
Purpose of the Study:
- To assess the impact of technological interventions, including continuous glucose monitors (CGM) and continuous subcutaneous insulin infusion (CSII) devices, on HgbA1c reduction in pediatric T1D patients with HgbA1c > 10%.
- To evaluate the association between the frequency of clinic visits and HgbA1c improvement in this patient cohort.
- To identify factors influencing the achievement of a clinically meaningful HgbA1c reduction (>0.5%).
Main Methods:
- A retrospective chart review was conducted for patients diagnosed with T1D for over one year between 2018 and 2019.
- Data analyzed included patient demographics, treatment modalities (CGM, CSII, or no technology), and the number of clinic visits.
- The study focused on children with an initial HgbA1c level exceeding 10%.
Main Results:
- Among 147 children evaluated, those using CGM only (53%), CSII only (64%), or both (78%) showed a clinically significant HgbA1c reduction.
- A comparable reduction was observed in 60% of patients not using technology.
- Increased clinic visits (e.g., 4 visits) were associated with higher rates of HgbA1c reduction (70%) compared to fewer visits.
Conclusions:
- Both technological interventions and increased clinic visit frequency can contribute to meaningful HgbA1c reductions in children with T1D.
- The effectiveness of these interventions varies among individuals, suggesting that not all patients require intensive technological support or frequent visits.
- A personalized treatment approach, considering individual patient needs and responses, is crucial for optimizing HgbA1c levels in pediatric T1D care.
Objective:
Individuals with diabetes often have difficulty attaining a goal hemoglobin A1c < 7.0 %. Diabetes care is multifactorial, including medications, education, and lifestyle intervention. Individuals with a hemoglobin A1c (HgbA1c) > 10 % are especially at risk for complications. The aim of this study was to evaluate the association of technological interventions [continuous glucose monitors (CGM) and/or continuous subcutaneous insulin infusion devices (CSII, i.e. insulin pumps)] and frequency of clinic visits with improvement of HgbA1c values in children with type 1 diabetes (T1D) who have a HgbA1c > 10 %.
Research Design And Methods:
A chart review was performed for patients with T1D who had a HgbA1c > 10 % and a diagnosis of T1D for greater than 1 year between 2018 and 2019 analyzing demographic data, treatment modality, and frequency of visits to determine if a clinically meaningful HgbA1c reduction (>0.5 %) was achieved.
Results:
One hundred and forty-seven children were evaluated. Altogether, 9 children (53 %) with CGM only, 18 (64 %) with CSII only, and 14 (78 %) with combination use achieved a clinically significant reduction as compared to 50 (60 %) with no technology. When evaluating number of visits, 41 children (61 %) with 1-2 visits, 40 (60 %) with 3, 19 (70 %) with 4, and 5 (50 %) with 5-6 achieved reduction.
Conclusions:
These results show that while either use of technology or increased clinic visits may improve the ability to achieve meaningful HgbA1c reductions, this may not be true for all patients. While some patients may need numerous clinic visits, others may be able to make dramatic changes with only two visits. Similarly, while some may benefit from CGM use alone, others may improve their HgbA1c with a CSII or no technology. Given the intricacies of diabetes care, this data supports that patients would likely benefit from a tailored treatment plan catered to their individual needs to best optimize their HgbA1c.
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