Beverley Davey1, David Grant Segal. 1. Wits University Donald Gordon Medical Centre, Johannesburg, South Africa. bev@endo.co.za.
Abstract
BACKGROUND: Intensive diabetes management requires intensive insulin treatment and self-monitoring of blood glucose (SMBG) measurements to obtain immediate information on the status of the blood glucose level and to obtain data for pattern analysis on which meal planning, insulin and lifestyle adjustments can be made. The value and optimal frequency of SMBGs are often questioned. OBJECTIVES: To document the relationship between SMBG frequency and glycaemic control in a managed care paediatric type 1 diabetes practice. METHODS: A retrospective analysis was performed on 141 managed care paediatric and adolescent patients over a 1-year period from 1 February 2010 to 30 January 2011. The patients were stratified according to their insulin regimen, frequency of SMBG was analysed, and glycaemic control was measured by glycated haemoglobin (HbA1c). RESULTS: The records of 141 paediatric and adolescent children aged 2 - 18 years were examined. A highly significant decrease (p<0.0001) in HbA1c was found when moving from two injections per day to three- and five-injection regimens. The average HbA1c and its variability reduced as the diabetes regimen became more intensive. A highly significant decrease (p<0.001) in HbA1c levels was detected as the frequency of SMBG increased, with an average decrease of 0.19% in HbA1c per unit increase in the number of SMBG measurements performed per day. The modal frequency of five SMBG measurements per day was required to achieve the American Diabetes Association and International Society for Pediatric and Adolescent Diabetes guideline recommended target HbA1c of <7.5% for a paediatric population. CONCLUSION: A beneficial relationship exists between frequency of SMBG and lower HbA1c in paediatric patients with type 1 diabetes.
BACKGROUND: Intensive diabetes management requires intensive insulin treatment and self-monitoring of blood glucose (SMBG) measurements to obtain immediate information on the status of the blood glucose level and to obtain data for pattern analysis on which meal planning, insulin and lifestyle adjustments can be made. The value and optimal frequency of SMBGs are often questioned. OBJECTIVES: To document the relationship between SMBG frequency and glycaemic control in a managed care paediatric type 1 diabetes practice. METHODS: A retrospective analysis was performed on 141 managed care paediatric and adolescent patients over a 1-year period from 1 February 2010 to 30 January 2011. The patients were stratified according to their insulin regimen, frequency of SMBG was analysed, and glycaemic control was measured by glycated haemoglobin (HbA1c). RESULTS: The records of 141 paediatric and adolescent children aged 2 - 18 years were examined. A highly significant decrease (p<0.0001) in HbA1c was found when moving from two injections per day to three- and five-injection regimens. The average HbA1c and its variability reduced as the diabetes regimen became more intensive. A highly significant decrease (p<0.001) in HbA1c levels was detected as the frequency of SMBG increased, with an average decrease of 0.19% in HbA1c per unit increase in the number of SMBG measurements performed per day. The modal frequency of five SMBG measurements per day was required to achieve the American Diabetes Association and International Society for Pediatric and Adolescent Diabetes guideline recommended target HbA1c of <7.5% for a paediatric population. CONCLUSION: A beneficial relationship exists between frequency of SMBG and lower HbA1c in paediatric patients with type 1 diabetes.