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Australian data show glycaemic control lacking in young patients with type 1 diabetes

By Jane Lewis
More than two-thirds of children and adolescents with type 1 diabetes in Australia are not meeting the recognised HbA1c target, and there is an ‘urgent need’ to identify barriers to achieving optimal glycaemic control in this population, researchers report in the MJA. In ‘the first nationwide snapshot of Australian children and adolescents with type 1 diabetes,’ the researchers said it was ‘worrying’ that so few patients were meeting recommended targets. 

‘Achieving good glycaemic control in the early years is very important in terms of metabolic memory,’ commented Professor Maria Craig, paediatric endocrinologist at St George Hospital and The Children’s Hospital at Westmead, Sydney, and senior author of the study. ‘It is critical that we support young people to achieve better control, to reduce their risk of complications.’ 

‘GPs can play an important role as part of the diabetes team, and can use general consultations to ask how a patient’s diabetes management is going. Many patients need psychological support, so referral for this aspect of care may be needed as part of the chronic care plan,’ she told Endocrinology Today

The study was based on data extracted from the Australasian Diabetes Data Network registry, a prospective longitudinal register of data collected from the five largest paediatric diabetes centres in Australia. Among 3279 participants (mean age, 12.8 years; mean diabetes duration, 5.7 years), only 27% were found to have achieved the national HbA1c target of less than 58 mmol/mol. The proportion meeting this target declined with age, from 34% of those aged 6 years or less to 25% of those aged 14 to 18 years. 

Overall, 44% of participants were being treated with continuous subcutaneous insulin infusion, 38% with multiple daily injections of insulin and 18% with twice­-daily insulin injections. Rates of overweight and obesity were higher among participants than for this age group in the general population (33% vs 27%). 

‘Overweight and obesity are very common in type 1 diabetes, and this is likely a consequence of the need for supraphysiological doses of insulin and the focus on eating, as well as reflecting the widespread problem of overweight in the community, Professor Craig said. ‘Encouraging a healthy lifestyle is important; however, technology does have a role to play and can support improved control,’ she said, adding that the Australian Federal Government-­subsided continuous glucose monitoring program is due to be rolled out from 1st April 2017.
Med J Aust 2017; 206: 121-125. 

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