Royal College of Surgeons in Ireland
Browse
Close intervention sessions complement intensive insulin therapy in paediatric diabetes a longitudinal study_.pdf (1.03 MB)

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

Download (1.03 MB)
Version 2 2023-10-13, 12:00
Version 1 2023-07-25, 16:44
journal contribution
posted on 2023-10-13, 12:00 authored by Jason Foran, Aisling Egan, Eric Somers, Susan O'ConnellSusan O'Connell

Objective: 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.

Design: 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.

Setting: A large tertiary paediatric diabetes centre using a prospectively maintained database of clinical encounters from 2007 to 2020.

Main outcome measures: Difference in HbA1c between treatment types (matching methodology) and expected change in HbA1c with treatment type and re-education (panel data).

Results: 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.

Conclusions: 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.

History

Comments

The original article is available at https://adc.bmj.com/

Published Citation

Foran J, Egan A, Somers E, O'Connell SM. Close intervention sessions complement intensive insulin therapy in paediatric diabetes: a longitudinal study. Arch Dis Child. 2023;108(10):818-823

Publication Date

4 July 2023

PubMed ID

37402632

Department/Unit

  • Paediatrics

Publisher

BMJ Pub. Group

Version

  • Published Version (Version of Record)

Usage metrics

    Royal College of Surgeons in Ireland

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC