SUN-140 The Ways of Achievement the Target Levels of Glycemic Control in Children and Adolescents with Type 1 Diabetes

Objective - to improve the level of glycemic control in patients with type 1 diabetes with the help of a flexible regimen of bolus insulin and a system of continuous glucose monitoring; the clinical use of the glycated hemoglobin and 1,5-anhydroglucitol as a marker of glycemic control. Materials and methods. 20 patients with type 1 diabetes aged 10 to 17 years were examined, with a duration of diabetes from 0.5 to 5 years, with the optimal or suboptimal glycemic control (1st group). The control group consisted of 14 patients with type 1 diabetes of appropriate age (2(nd) group). The patients checked glycemic level using glucose meters up to 10 times a day at home or used continuous glucose monitoring. A flexible regimen of insulin titration was used by calculating the carbohydrate and insulin sensitivity factors. During the study we determined HbA1c and 1,5-AG level in all patients. Results and discussion. We used 1.5­AG value for assessment the variability of changes in glycaemia. 1.5­AG level was in range of 1.0 to 9.2 mcg/ml. We have identified a reverse causality between HbA1с and 1.5­AG level. The level of HbA1c decreased from 0,2 to 1,9 % in ten patients after three months on the flexible mode of titration and continuous glucose monitoring, in 1 - remained stable, in 2 - increased from 0,1 to 0,4 % (mean (6,89 ± 0,14 %), P < 0,001 relative to the baseline, P < 0,01 relative to changes in the control group. The average level of HbA1c in the control group was (7,68 ± 0,17 %). After 9 months, the levels of HbA1c in patients from the main group were (7,2 ± 0,12 %), P <0.01 relative to baseline and relative to changes in the control group (7,8 ± 0,14 %). The level of 1,5-AG in the main group increased to (6,31 ± 0,64), P <0.05 relative to the baseline level. Conclusions: The amount of 1,5-AG can be used to find out the presence of significant glycemic excursions in a short period of time (2 weeks). Using the 1,5-AG together with HbA1c provided a better understanding of the glycemic control in a particular patient. The flexible regimen of insulin titration and continuous glucose monitoring are the modern methods for improving diabetes management. Key words: diabetes mellitus type 1, children, 1,5-anhydroglucitol, glycated hemoglobin, self-control, insulin therapy