Achievement of metabolic control goals set by the American Diabetes Association and the International Society for Pediatric and Adolescent Diabetes in pediatric patients with type 1 diabetes from Spain.

AIM: The "T1D Exchange Clinic Registry" of 13.316 pediatric patients with type 1 diabetes (T1D) in U.S. recently revealed that most children have HbA1c values above target levels established by the American Diabetes Association (ADA) and the International Society for Pediatric and Adolescent Diabetes (ISPAD). The aim of this study is to assess the proportion of youngsters with T1D who meet the internationally accepted targets for good metabolic control of diabetes at a single, referral Pediatric Diabetes Center in Spain. PATIENTS AND METHODS: Cross-sectional study of 236 children and adolescents with T1D controlled at our Pediatric Diabetes Unit. We analyzed the compliance to metabolic goals set by ADA and ISPAD and the differences between patients treated with continuous subcutaneous insulin infusion and multiple daily injections. STATISTICS: SPSS™ version 21.0. RESULTS: Mean age: 12.6 ± 4.6 years old, mean age at diagnosis: 6.1 ± 4.3 years old and mean diabetes duration: 6.4 ± 4.3 years; 47% female. HbA1c average: 6.7 ± 0.7% (49.7 ± 7.6 mmol/mol). The age-specific ADA and ISPAD HbA1c targets were achieved by 93% and 91% of patients, respectively. Among pump users, 97%/97% met ADA/ISPAD HbA1c targets compared to 87%/88% of MDI users (p = 0.04/p = 0.03), without significant differences in the analysis by groups of age. Among participants, 95%, 62%, 95%, 98% and 89% met HDLc, LDLc, triglycerides, BP and BMI targets. CONCLUSIONS: Most patients in our children and adolescent cohort of T1D patients correctly achieve metabolic goals established by ADA and ISPAD with low incidence of hypoglycemia.

Insulin dose adjustment when changing from multiple daily injections to continuous subcutaneous insulin infusion in the pediatric age group.

The aim of this study is to determine the proper initial dose adjustment when switching from multiple daily injections to continuous subcutaneous insulin infusion for type-1 diabetic pediatric patients. Our hypothesis is that the insulin adjustment varies depending on the pubertal status and the previous long-acting insulin used. Charts of 60 patients were reviewed. Data regarding insulin dose, type of insulin administrated, HbA1c, BMI, severe hypoglycemia and DKA events were collected during the previous year and after 6 weeks of pump therapy. In the prepubertal patients the reduction was 19% (26% if the previous insulin used was detemir). Pubertal patients experienced a decrease of 26%, and the detemir group 33%. The ratio long acting-basal/short acting-bolus insulin changed from 1.26 ± 0.84 to 0.93 ± 0.46 (P < 0.05). The total daily insulin dose needs to be decreased. Basal insulin constitutes 40-45% in prepubertal and 45-50% in pubertal patients. The reduction is different depending on the previous long-acting insulin used; being greater if the insulin is detemir.