Achieving meaningful reduction of HgbA1c in pediatric type 1 diabetes requires an individualized approach.

Abstract

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 %. 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. 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. 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.