The Impact of Multi-Disciplinary Input on Glycaemic Control Over Time in Children on Intensive Insulin Therapy Using Real World Prospectively Collected Data

Aims: To investigate the factors impacting on glycaemic control over time including treatment type, educational input and patient demographics within an Irish tertiary paediatric diabetes centre. Methods: Using a prospectively maintained database of clinical encounters, data was analysed in age matched pairs from 2007 to 2019. Pairs were matched by insulin treatment type (pump v multiple daily injection (MDI)). Matching was performed on the basis of gender, current age, age at diagnosis and HbA1c at pump commencement. Panel data regression was performed on the entire sample and analysed for the impact of differing insulin regimens by gender, age and duration of diagnosis. This model was then used to assess the impact of intensive re-education sessions on HbA1c. Results: From 999 patients there were 104 matched pairs. Compared to MDI, matched pump patients had a lower HbA1c 6 months after commencement [Difference in HbA1c = 0.60% p <0.01], this effect persisted to 8 years [0.57% p=0.01]. Panel data analysis showed CSII therapy reduces HbA1c by 0.57% relative to MDI therapy (p<0.001). Patients who required intensive re-education showed a HbA1c 0.91% greater than otherwise identical patients prior to re-education, after these sessions HbA1c drops by a statistically significant 0.79% (p<0.001). Conclusions: Compared to matched peers on MDI treatment regimens, patients on pump therapy showed significant improvements in HbA1c which was an effect sustained up to 8 years. Panel data regression confirms these findings and in addition shows that intensive re-education is associated with a significant drop in previously elevated HbA1c levels.