Initiation of insulin adjustment for carbohydrate at onset of diabetes in children using a home-based education programme with a bolus calculator

Abstract

Improved glycaemic control following diagnosis of type 1 diabetes is associated with improved control in the longer term. This study reports on the experience of a paediatric diabetes service that introduced insulin adjustment for blood glucose and carbohydrate meal content from the first day of diagnosis. This is provided via a newly-designed home education programme, using multiple daily injections of insulin, supported by a bolus calculator blood glucose meter. Glycaemic control was compared between patients who received the new programme (those diagnosed July 2012 to March 2014) to two historical cohorts: January 2000 to December 2009 and January 2010 to June 2012. The primary outcome was HbA1c at 4–6 months post-diagnosis. Secondary outcomes were HbA1c at 10–12 months post-diagnosis and the percentage of patients achieving HbA1c of <58mmol/mol in the first 12 months. Twenty-seven children (16 male, mean age 9.7 ± 3.1) completed the new education package beyond 12 months. HbA1c was significantly lower in the 2012–14 cohort when compared to the 2000–09 and 2010–12 cohorts at 4–6 and 10–12 months (mean [95% CI] mmol/mol: 4–6 months 52[47–57] vs 68[65–71] vs 65[61–68]; 10–12 months 57[53–61] vs 72[70–75] vs 71[67–76] p < 0.001). In all, 89% of those diagnosed in 2012–14 achieved HbA1c <58mmol/mol within the 12 months post-diagnosis compared with 39% in the 2010–12 cohort and 45% in the 2000–09 cohort (p < 0.001). In conclusion, carbohydrate counting with the use of a bolus calculator blood glucose meter at diagnosis was successfully introduced to a home-based education programme. This approach has improved glycaemic control in the first year of diagnosis, which may have a positive impact on long-term glycaemic control.