Title: 1238 Not being in DKA on admission and normalising blood glucose values from onset key to excellent HbA1C values one year after diagnosis of type 1 diabetes
Abstract:<h3>Background</h3> NICE guidance recommends paediatric patients with Type 1 Diabetes Mellitus (T1DM) should achieve a HbA1c target level of 48mmol/mol (6.5%) or lower. <h3>Objectives</h3> We therefor...<h3>Background</h3> NICE guidance recommends paediatric patients with Type 1 Diabetes Mellitus (T1DM) should achieve a HbA1c target level of 48mmol/mol (6.5%) or lower. <h3>Objectives</h3> We therefore wanted to investigate potential factors that led to an optimal HbA1c one year after diagnosis in paediatric patients. <h3>Methods</h3> We did a case review of paediatric patients newly diagnosed with T1DM from 01/01/17 to 31/12/20 who are managed by the paediatric diabetes team at Doncaster Royal Infirmary. Factors we looked at included initial presentation (DKA or no DKA), gender, index of multiple deprivation, family structure and average glucose control at week 1,week 2 and one month. We compared these factors with HbA1c at 1 one year to establish any patterns associated with better control, as dictated by HbA1c <48 mmol/mol (6.5%). <h3>Results</h3> 9 newly diagnosed T1DM patient were identified. 37.5% (18 patients) presented with diabetic ketoacidosis (DKA) at diagnosis. 88.9% of children who presented with DKA at diagnosis had a HbA1C >48mmol/mol one year after diagnosis. There was a positive correlation between lower average blood glucose values one week, two weeks and one month after diagnosis with lower HbA1c values at one year. On Sub-analysis of patients with HbA1c <48mmol/mol and HbA1c >70mmol/mol, the mean blood glucose at one week, two week and one month were much lower in the <48mmol/mol group compared to the >70mmol/mol group. No associations with age at diagnosis, index of multiple deprivation decile, and two parent households were found. <h3>Conclusions</h3> Evidence from this case review shows that identifying diabetes early (thereby preventing development of DKA) and achieving target bloods glucose values from the outset of diagnosis can lead to an optimal HbA1C (48mmol.mol or lower) one year after diagnosis. More awareness needs to be created among primary care and paediatric teams in recognising symptoms of diabetes and the importance of normalising blood glucose values early.Read More