The impact of a diabetes care team on the glycaemic control of paediatric and adolescent patients with type 1 diabetes mellitus at Tygerberg Children’s Hospital

Abstract

Background. A diabetes care team (DCT) may contribute to improved glycaemic control in type 1 diabetes mellitus (T1DM) patients. Hence a DCT was introduced at Tygerberg Children’s Hospital (TCH) in 2009. 

Hypothesis. A DCT for T1DM patients improves HbA1c, reduces admission and diabetic ketoacidosis (DKA) rates and insulin dose, and decreases the prevalence of complications. 

Methods. In this retrospective cohort study, records of 190 T1DM patients attending the paediatric diabetic clinic at TCH between August 2004 and July 2011 were reviewed. Data extracted include: glycated haemoglobin (HbA1c) levels; total number of admissions; DKA and recurrent DKA (rDKA) admissions; insulin regimen and dose; and presence of complications. Four periods, in which specific changes to team composition occurred, were compared. 

Results. HbA1c levels increased from 9.0% (7.85 - 10.15) in P1 to 10.9% (9.6 - 12.2) in P2, but decreased to 9.3% (8.75 - 9.75) in P4 (p=0.02). The number of admissions decreased from 0.79 (0.46 - 1.12) to 0.18 (0.02 - 0.34) (p=0.01). The DKA rate decreased from 32.5/100 patient years to 23.5/100 patient years. The rDKA rate decreased from 18.8% in P1 to 9.6% in P4. Daily insulin injections increased from 2.97 (2.85 - 3.01) to 3.06 (3.06 - 3.23) (p=0.01). The mean insulin dose decreased from 1.19 (1.08 - 1.31) to 0.93 (0.87 - 1.00) units/kg/day (p=0.00). 

Conclusion. After the introduction of the DCT, HbA1c levels were less variable and hospital admission and DKA rates decreased. Improvements were achieved with a multiple injection regimen at a lower daily insulin dose.