Abstract
AIMS: To examine the impact of intensive management of type 1 diabetes (T1D) from diagnosis on HbA(1c )12 months from diagnosis. METHODS: HbA(1c )measured 12 months after diagnosis for 70 consecutively newly diagnosed children with T1D following implementation of an intensive management protocol was compared with 70 children consecutively diagnosed immediately pre-implementation. Intensive management involved carbohydrate counting and flexible insulin dosing from first meal with subcutaneous insulin, targeted blood glucose levels from 4-8mmol/L irrespective of time of day, avoidance of twice daily insulin regimen and promotion of continuous glucose monitoring (CGM). HbA(1c), diabetes technology use and insulin regimen at 12 months post-diagnosis were compared. RESULTS: The post-intensive management implementation cohort had an improved mean HbA(1c )of 58.2 +/- 15.3mmol/mol vs 63.7 +/- 10.7mmol/mol at 12 months (p=0.014). The proportion of young people with diabetes meeting a target HbA(1c) of <53mmol/mol at 12 months improved from 11% to 40% (p=<0.001). There was a reduction of twice daily insulin regimen from 66% to 11% (p=<0.001), and increased CGM use from 57% to 76% (p=0.02). CONCLUSION: Intensive management when implemented with consistent messaging from the multi-disciplinary team resulted in clinic-wide improvements in HbA(1c )and the proportion meeting HbA(1c )targets.