The effect of automated bolus calculators on HbA1c in children with type 1 diabetes in Macclesfield
Hormone Research in Paediatrics, October 2013, vol./is. 80/(413), 1663-2818
Background: Previous studies have shown that using Automated bolus calculators (ABC) in type1 diabetic children showed noticeable reduction in HbA1C(1). Furthermore, it showed reduction in post prandial blood glucose level(2) and glucose variability(3) for those children treated with insulin pumps. Data from adults has already shown improvement in HbA1C following usage of ABC(4).
Objective: To confirm the effect of ABC on HbA1C in children with type1 diabetes who are on multiple daily insulin injection regimes in our unit.
Methods: This is a cross-sectional study. We have collected the data via Accu-check software and by reviewing the case notes. HbA1C was measured
before and after ABC use. Some of the patients were started immediately on ABC following their diagnosis with diabetes and others were started later after they showed poor glycaemic control.
Results: 22 patients were identified (age 6-15 years, M:F 10:12) with a duration of diabetes before being started on ABC 0-11 years, but with median of 7.5 months. The HbA1C was monitored over an average period of 18 months (4-30 months). There was an improvement in HbA1C in 59%, their average age was 12 years (M:F 6:7). There was a 3% (33 mmol/mol) reduction in median HbA1C for this group post ABC use. (Median HbA1C pre ABC 90.9 mmol/mol (10.8% +/-2.4) while post ABC was 58 mmol/ml (7.8% +/-0.9). 9 patients had a raise in their HbA1C by 1% (pre ABC 8.4% +/-1.27 and after 9.4% +/-1.34). Their average age was 13 years (M:F 4:5). They were less frequently checking their blood glucose (average of 3.5 times per day, versus the other group 4.8 times per day) and hence using the ABC less often.
Conclusion: Our results show that ABC’s work best for children and young people who check their blood sugars more often. These results are really encouraging towards finding out about the role of other relevant factors e.g. education and training which might play a role in improving control. RCT with larger patient numbers is needed.
Journal: Conference Abstract