Temporal trends in the treatment of pediatric type 1 diabetes and impact on acute outcomes.
OBJECTIVE
To evaluate temporal trends in pediatric type 1 diabetes (T1DM) management and resultant effects on outcomes.


METHODS
Two pediatric T1DM cohorts were followed prospectively for 2 years and compared; Cohort 1 (N = 299) was enrolled in 1997 and Cohort 2 (N = 152) was enrolled in 2002. In both cohorts, eligible participants were identified and sequentially approached at regularly scheduled clinic visits until the target number of participants was reached. Main outcome measures were hemoglobin A1c (A1c), body mass index Z score (Z-BMI), and incidence rate (IR; per 100 patient-years) of hypoglycemia, hospitalizations, and emergency room (ER) visits.


RESULTS
At baseline, Cohort 2 monitored blood glucose more frequently than Cohort 1 (> or = 4 times/day: 72% vs 39%, P < .001) and was prescribed more intensive therapy than Cohort 1 (> or = 3 injections/day or pump: 85% vs 65%, P < .001). A1c was lower in Cohort 2 than Cohort 1 at baseline (8.4% vs 8.7%, P = .03) and study's end (8.7% vs 9.0%, P = .04). The cohorts did not differ in Z-BMI (0.83 vs 0.79, P = .57) or IR of hospitalizations (11.2 vs 12.9, P = .38). Cohort 2 had lower IR of total severe hypoglycemic events (29.4 vs 55.4, P < .001) and ER visits (22.0 vs 29.3, P = .02).


CONCLUSIONS
T1DM management intensified during the 5 years between cohorts and was accompanied by improved A1c and stable Z-BMI. Along with improved control, IR of severe hypoglycemia and ER visits decreased by almost 50% and 25%, respectively.
Svoren
Britta M
BM
Pediatric and Adolescent Section, Joslin Diabetes Center, Boston, Massachusetts 02215, USA.
Volkening
Lisa K
LK
Butler
Deborah A
DA
Moreland
Elaine C
EC
Anderson
Barbara J
BJ
Laffel
Lori M B
LM
D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring; D002648:Child; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000188:drug therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005951:Glucose Tolerance Test; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology / Q000517:prevention & control*; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D011336:Probability; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D001786:Blood Glucose; D007328:Insulin