The Impact of Expanding Diabetes Services on the Trend of Glycemic Control in Children and Adolescents with Type 1 Diabetes

Abstract

Objectives. Our aim is to evaluate the impact of initiating a specialized children’s hospital and expanding the diabetes service for children with type 1 diabetes (T1D) on their glycemic control and on acute–diabetes-related complications over a 4-year follow-up period. Methods. This was a retrospective cohort study that included children aged 1–16 years with T1D, diagnosed for at least 1 year, and treated with multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). The study period extended from January 1, 2016 to December 31, 2019. Outcomes included the trend of glycemic control measured by HgbA1c and acute–diabetes-related complications, such as hypoglycemia, hyperglycemia, and diabetic ketoacidosis (DKA), reflected by the number of emergency room (ER) visits. Additionally, the number of visits per patient per year was captured over the 4-year study period. Results. Four hundred ninety-nine patients with T1D were included in the study (48.9% female). The mean age was 13.4 years (±2.0) in the CSII group and 12.4 years (±2.2) in the MDI group. Three thousand nine hundred and six visits were reviewed, with 618 in the CSII group and 3,288 in the MDI group. The mean hemoglobin A1c (HgbA1c) for the whole cohort was 10.56% at the start of the study period in 2016 and dropped by 0.67% to a mean of 9.89% in 2019 (p-value = 0.025). There was a 0.67% decline in the HgbA1c of the MDI group and a 0.47% decrease in the CSII group ($p=<0.001$). The average number of clinic visits per patient per year increased from 2.6 in 2016 to 2.8 in 2019. ER visits slightly decreased throughout the 4-year period (p-value = 0.46). Conclusion. Increased accessibility of the diabetes care team to children and adolescents with T1D and their families, with more frequent contact with team members, contributes significantly to the improvement of glycemic control.