Glycemic control in children with type 1 diabetes mellitus - predictors and implications

OBJECTIVES: To identify the predictors of poor glycemic control in type 1 DM children based on demographic and disease related data,prevalence of poor glycemic control and morbidities associated with poor glycemic control and effect of carb counting on HbA1c by doing a nested case control study using ISPAD guidelines for grouping the children as good/poor control. METHODOLOGY 112 children were enrolled into this nested case control study and after informed consent was obtained, history was asked regarding demographic and disease related data. Blood was drawn for HbA1c measurements, carb counting was explained and patients were advised to come after three months for a repeat measurement. They were grouped into good and poor controls using ISPAD cutoffs and statistical analysis was carried out to find out significant associations between each of the demographic and disease related data with their glycemic control. RESULTS AND CONCLUSIONS: The gender and the birth order did not contribute significantly as a predictor. The children from rural areas were found to have better control, however it was not statistically significant.Those with a positive family history had a better glycemic control and was found to be a statistically significant predictor of good glycemic control.The parents educational status and employment did not impact the glycemic control of the children.The socioeconomic status of the affected childrens’ families did not correlate significantly with glycemic control. Although 99% of the children were living with the parents and the mother was the primary caregiver, this did not ensure good glycemic control. The age of onset had no bearing on the glycemic control, however those with longer duration of the disease (>10years) seemed to have a better control though not statistically significant. Majority of the patients measured the SMBG only twice a week due to logistic reasons .Carb counting which was followed by 96% of the patients yielded in an improvement of 6.4% of the patients with poor control improving to have a good glycemic control on the repeat hba1c measurement. 65% of the patients attended the diabetic clinic only once a month. which did not ensure good glycemic control. BMI did not statistically correlate with the glycemic control. It was concluded that more frequent monitoring of SMBG was necessary to have a good glycemic control which was not possible at our institute due to logistic reasons