Therapeutic goals have been established to decrease the risk of long-term complications of type 1 diabetes (T1DM). The effects of these guidelines should be constantly evaluated. Hence, the present study examines the frequency at which children with T1DM treated by one of the Polish reference centers complied with the therapeutic targets issued in 2014 by the International Society for Pediatric and Adolescent Diabetes (ISPAD) and by the Diabetes Poland (PTD).
A retrospective analysis (years 2011–2014) was performed in patients with T1DM aged 6.5–18 years, with diabetes duration >12 months and no change of insulin regimen within 6 months. Collected data included insulin therapy regimen, weight, height, blood pressure, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and glycated hemoglobin (HbA1c) level from the last hospitalization.
The records of 447 patients (260 boys, 299 treated with insulin pump) were analyzed. All ISPAD goals were achieved by 123 (27.5%) patients, but only 43 (9.6%) met all PTD targets. Optimal HbA1c was achieved by 224 (50.1%) according to ISPAD criteria (HbA1c<7.5%) and by 87 (19.6%) patients according to PTD (HbA1c≤6.5%). Obesity was diagnosed in 11.6% of the patients; 19.7% of the patients were overweight. In logistic regression, patient age was the only independent predictor of failing to achieve complete T1DM control (p=0.001, OR=1.12 [1.05–1.23]) and optimal HbA1c (p=0.01, OR=1.1 [1.0–1.2]) according to ISPAD guidelines. Moreover, girls had a greater risk of failing body mass index (BMI) targets (PTD: p=0.002, OR=2.16; ISPAD: p=0.0001, OR=3.37) and LDL-C targets (p=0.005, OR=1.8) than boys.
Overall, control of vascular risk factors in Polish children with T1DM is unsatisfactory. While too few children are achieving the HbA1c target set by PTD, it is possible that such strict national target helps half of the Polish school-age patients achieve ISPAD-issued aim which is more liberal. High prevalence of overweight among children with T1DM warrants initiatives focused not only on glycemic control but also on motivation of patients to lead a healthy lifestyle.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
1. Chobot A, Polanska J, Brandt A, Deja G, Glowinska-Olszewska B, et al. Updated 24-year trend of type 1 diabetes incidence in children in Poland reveals a sinusoidal pattern and sustained increase. Diabet Med 2017;34:1252–8. Search in Google Scholar
2. Szalecki M, Wysocka-Mincewicz M, Ramotowska A, Mazur A, Lisowicz L, et al. Epidemiology of type 1 diabetes in Polish children: a multicentre cohort study. Diabetes Metab Res Rev 2017:e2962. Search in Google Scholar
3. Jacobson AM, Braffett BH, Cleary PA, Gubitosi-Klug RA, Larkin ME, et al. The long-term effects of type 1 diabetes treatment and complications on health-related quality of life: a 23-year follow-up of the Diabetes Control and Complications/Epidemiology of Diabetes Interventions and Complications cohort. Diabetes Care 2013;36:3131–8. Search in Google Scholar
4. Marshall SM, Flyvbjerg A. Prevention and early detection of vascular complications of diabetes. BMJ 2006;333:475–80. Search in Google Scholar
5. American Diabetes Association. Standards of Medical Care in Diabetes – 2014. Diabetes Care 2014;37:S14–80. Search in Google Scholar
6. Diabetes Poland. Zalecenia kliniczne dotyczące postępowania u chorych na cukrzycę 2014 [2014 Guidelines on the management of diabetic patients – position of Diabetes Poland] Clin Diabetol 2014:1–46. Search in Google Scholar
7. de Beaufort CE, Swift PG, Skinner CT, Aanstoot HJ, Aman J, et al. Continuing stability of center differences in pediatric diabetes care: do advances in diabetes treatment improve outcome? The Hvidoere Study Group on Childhood Diabetes. Diabetes Care 2007;30:2245–50. Search in Google Scholar
8. Cameron FJ, de Beaufort C, Aanstoot HJ, Hoey H, Lange K, et al. Lessons from the Hvidoere International Study Group on childhood diabetes: be dogmatic about outcome and flexible in approach. Pediatr Diabetes 2013;14:473–80. Search in Google Scholar
9. Braun M, Tomasik B, Wrona E, Fendler W, Jarosz-Chobot P, et al. The stricter the better? The relationship between targeted HbA1c values and metabolic control of pediatric type 1 diabetes mellitus. J Diabetes Res 2016;2016:5490258. Search in Google Scholar
10. Diabetes (type 1 and type 2) in children and young people: diagnosis and management | Guidance and guidelines | NICE n.d. https://www.nice.org.uk/guidance/ng18. Accessed 4 May 2018. Search in Google Scholar
11. Nathan DM. The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: overview. Diabetes Care 2014;37:9–16. Search in Google Scholar
12. Bulut T, Demirel F, Metin A. The prevalence of dyslipidemia and associated factors in children and adolescents with type 1 diabetes. J Pediatr Endocrinol Metab 2017;30:181–7. Search in Google Scholar
13. Datye KA, Moore DJ, Russell WE, Jaser SS. A review of adolescent adherence in type 1 diabetes and the untapped potential of diabetes providers to improve outcomes. Curr Diab Rep 2015;15:51. Search in Google Scholar
14. Donaghue KC, Wadwa RP, Dimeglio LA, Wong TY, Chiarelli F, et al. ISPAD Clinical Practice Consensus Guidelines 2014. Microvascular and macrovascular complications in children and adolescents. Pediatr Diabetes 2014;15(Suppl 20):257–69. Search in Google Scholar
15. Clements MA, Foster NC, Maahs DM, Schatz DA, Olson BA, et al. Hemoglobin A1c (HbA1c) changes over time among adolescent and young adult participants in the T1D exchange clinic registry. Pediatr Diabetes 2016;17:327–36. Search in Google Scholar
16. Bjornstad P, Pyle L, Nguyen N, Snell-Bergeon JK, Bishop FK, et al. Achieving International Society for Pediatric and Adolescent Diabetes and American Diabetes Association clinical guidelines offers cardiorenal protection for youth with type 1 diabetes. Pediatr Diabetes 2015;16:22–30. Search in Google Scholar
17. Pawłowska A, Horodnicka-józwa A, Petriczko E, Bonisławska A, Ksel J, et al. Ocena realizacji zaleceń dotyczących postępowania z dziećmi chorymi na cukrzycę typu 1 na podstawie wytycznych Polskiego Towarzystwa Diabetologicznego (PTD) oraz Międzynarodowego Stowarzyszenia ds. Cukrzycy u Dzieci i Młodzieży (ISPAD) – badania pilotażowe [Assessment of the Implementations of the Recommendations in Children with Type 1 Diabetes Based on Guidelines of Polish Diabetes Association (PTD) and International Society for Pediatric and Adolescent Diabetes – A Pilot Study]. Pediatr Endocrinol 2012;11:29–44. Search in Google Scholar
18. Jarosz-Chobot P, Polanska J, Mysliwiec M, Szadkowska A, Fendler W, et al. Multicenter cross-sectional analysis of values of glycated haemoglobin (HbA1c) in Polish children and adolescents with long-term type 1 diabetes in Poland: PolPeDiab study group. Pediatr Endocrinol Diabetes Metab 2012;18:125–9. Search in Google Scholar
19. Enes P, Yelmo R, Alonso M, Barrio R. 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. Diabetes Res Clin Pract 2015;107:300–5. Search in Google Scholar
20. Mianowska B, Szadkowska A, Pietrzak I, Czerniawska E, Fendler W, et al. Cross-sectional evaluation of metabolic control as reflected by HbA1c in children with type 1 diabetes mellitus. Przegląd Pediatryczny 2009;39:243–7. Search in Google Scholar
21. Szypowska A, Schwandt A, Svensson J, Shalitin S, Cardona-Hernandez R, et al. Insulin pump therapy in children with type 1 diabetes: analysis of data from the SWEET registry. Pediatr Diabetes 2016;17:38–45. Search in Google Scholar
22. Tucker M. TEENS: most youth with type 1 diabetes miss glycemic goals. 74th American Diabetes Association 2014 Scientific Sessions, June 13–14 2014, San Francisco. Search in Google Scholar
23. Marcovecchio ML, Woodside J, Jones T, Daneman D, Neil A, et al. Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT): urinary screening and baseline biochemical and cardiovascular assessments. Diabetes Care 2014;37: 805–13. Search in Google Scholar
24. National Paediatric Diabetes Audit 2014–15 Report 1: Care Processes and Outcomes, 2016. Search in Google Scholar
25. Laakso M, Cederberg H. Glucose control in diabetes: which target level to aim for? J Intern Med 2012;272:1–12. Search in Google Scholar
26. Stevens RJ, Kothari V, Adler AI, Stratton IM. The UKPDS risk engine: a model for the risk of coronary heart disease in Type II diabetes (UKPDS 56). Clin Sci (Lond) 2001;101:671–9. Search in Google Scholar
27. Lagani V, Chiarugi F, Thomson S, Fursse J, Lakasing E, et al. Development and validation of risk assessment models for diabetes-related complications based on the DCCT/EDIC data. J Diabetes Complications 2015;29:479–87. Search in Google Scholar
28. Pinhas-Hamiel O, Levek-Motola N, Kaidar K, Boyko V, Tisch E, et al. Prevalence of overweight, obesity and metabolic syndrome components in children, adolescents and young adults with type 1 diabetes mellitus. Diabetes Metab Res Rev 2015;31:76–84. Search in Google Scholar
29. Kapellen TM, Gausche R, Dost A, Wiegand S, Flechtner-Mors M, et al. Children and adolescents with type 1 diabetes in Germany are more overweight than healthy controls: results comparing DPV database and CrescNet database. J Pediatr Endocrinol Metab 2014;27:209–14. Search in Google Scholar
30. DuBose SN, Hermann JM, Tamborlane WV, Beck RW, Dost A, et al. Obesity in youth with type 1 diabetes in Germany, Austria, and the United States. J Pediatr 2015;167:627-32.e1–4. Search in Google Scholar
31. Ahuja A, Roopakala MS, Wilma Delphine Silvia CR, Reddy S, Prasanna Kumar KM. Glycated hemoglobin, dyslipidemia and risk of atherosclerosis in type 1 diabetic patients. Int J Diabetes Dev Ctries 2011;31:18–21. Search in Google Scholar
32. Maffeis C, Morandi A, Ventura E, Sabbion A, Contreas G, et al. Diet, physical, and biochemical characteristics of children and adolescents with type 1 diabetes: relationship between dietary fat and glucose control. Pediatr Diabetes 2012;13:137–46. Search in Google Scholar
33. Heyman E, Berthon P, Youssef H, Delamarche A, Briard D, et al. Metabolic dysfunction in late-puberty adolescent girls with type 1 diabetes: relationship to physical activity and dietary intakes. Diabetes Metab 2012;38:337–42. Search in Google Scholar
34. Rajpathak SN, Gunter MJ, Wylie-Rosett J, Ho GY, Kaplan RC, et al. The role of insulin-like growth factor-I and its binding proteins in glucose homeostasis and type 2 diabetes. Diabetes Metab Res Rev 2009:3–12. Search in Google Scholar
35. Jankowska A, Horodnicka-józwa A, Walczak M, Petriczko E, Syrenicz A, et al. [The Assessment of Selected Lipid Parameters in Children and Adolescents Suffering from Diabetes Mellitus Type 1]. Pediatr Endocrinol 2007;6:33–9. Search in Google Scholar
36. Pańkowska E, Lipka M, Wysocka M, Szypowska A, Trippenbach-Dulska H, et al. [Metabolic control in young children with type 1 diabetes treated with continuous subcutaneous insulin infusion (insulin pump)]. Endokrynol Diabetol Chor Przemiany Materii Wieku Rozw 2003;9:11–5. Search in Google Scholar
37. Minkina-Pędras M, Muchacka-Bianga M, Jarosz-Chobot P, Koehler B. Doświadczenia własne w leczeniu dzieci z cukrzycą typu 1 ciągłym podskórnym wlewem insuliny (doniesienie wstępne) [Treating children with type 1 diabetes with continuous subcutaneous insulin infusion – single centre experience, initial report]. Diabetol Doświadczalna Klin 2002;2:216–7. Search in Google Scholar
©2018 Walter de Gruyter GmbH, Berlin/Boston