The jury’s still out on the optimal approach to glycaemic control in paediatric type 1 diabetes patients, but Australian endocrinologists suggest individualised care could be a step in the right direction.
A team at Melbourne’s Royal Children’s Hospital have published their recommendation in the Journal of Paediatrics and Child Health, after finding outpatient and inpatient care of young T1D patients achieved comparable, sustained improvements in HbA1c levels over a 12 month period.
Of 70 age- and sex-matched patients with HbA1c above 9%, over a quarter of patients per group sustained a ≥2% decrease in HbA1c at 12 months and more than 66% of patients in each group sustained a ≥1% drop, the authors led by Paediatric Endocrinology Advanced Trainee Gabby Atlas wrote.
Patients were more likely to sustain their ≥2% HbA1c reduction at 12 months if they’d already achieved this reduction by six months, regardless of intervention strategy.
Although all individuals remained above the HbA1c target of <7% and at high risk of diabetes-related complications, the researchers considered intensive interventions that reduce HbA1c by ≥1 or 2% “worthwhile”.
The likelihood of diabetes-related complications increased exponentially from an HbA1c of 9%, they noted. Furthermore, children and adolescents were three times more likely to develop severe retinopathy in adulthood for every 1% increase in HbA1c, they added.
“Our results indicate that regardless of the nature of an intervention, if there has not been distinct improvement (characterised here by a reduction in HbA1c by 2% or more) after six months, an alternative approach should be considered in order to affect change,” they said.
And while this study’s interventions appeared “equally effective”, it was important to consider that inpatients had already failed outpatient intervention, they emphasised.
Therefore, “if an attempt at stabilisation on an outpatient basis is unsuccessful, inpatient stabilisation can offer significant benefit to those who have previously not seen significant reductions in HbA1c,” the authors wrote.
“We recommend an individualised approach to stabilisation, with review of the intervention’s success at 6 months with further intensification as needed.”
“Additional longitudinal data collection will provide more insight; however, prospective studies with a standardised model of care are required to assess the optimal intervention strategy for different patient groups”, they concluded.