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Pediatric to Adults—Lessons Learned 4 Years in Transitioning
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Abstracts / Can J Diabetes 37 (2013) S13eS84
Results: A1c averages decreased from 10.3% to 8.0% (n¼393); satisfaction survey results found that 97% of patients had an improvement in their ability to self-manage their disease. Conclusions: The CCDC has met first-year program goals, indicating a reduction in risk for complications of diabetes for the majority of enrolled patients. Future plans to increase program efficiencies will be discussed.
seemed to be related to later complications in early adulthood. HbA1c was inversely related to BMI in adolescents and young adults, suggesting a significant impact of management on weight status and obesity risk. Further studies are required to better identify those at risk of future complications.
90 88 Long-Term Glycemic Control in Patients on Insulin Pump Therapy CHRISTINE ORR, WILMA HOPMAN, JOY YEN, ROBYN HOULDEN Kingston, ON Insulin pumps are an effective method of intensive therapy for type 1 DM; however, studies have been <1 year and have not examined longer-term glycemic control. We performed a retrospective analysis of change in A1C in patients on insulin pump >1 year and analyzed factors influencing A1C. A1C values immediately prior to pump initiation and at 3- to 6-month and yearly intervals thereafter were analyzed for 200 patients (123 females, 77 males). Average age at pump initiation was 35.4 years (SD 14.7, range 9 to 76). Average duration of DM prior to pump was 22.4 years (SD 12.4, range 1 to 56). Mean duration of pump therapy was 6 years (SD 3.5, range 1 to 15). Mean A1C at initiation of pump was 8.7 (SD 1.7, range 5.6 to 15.8). Mean A1C initially decreased to a nadir of 7.5 at 3 to 6 months (SD 1.0, p<0.001) and increased over time (range 7.8 to 8.2%) but remained lower than pre-pump A1C (p<0.001). There was no difference in mean A1C between men and women at all durations. Missed appointments were a predictor of higher A1C on pump therapy. Pre-pump A1C predicted long-term A1C on pump therapy. Patients with pre-pump A1C <7% were likely to maintain A1C values in this range. Patients with A1C> 9% showed the greatest decline in A1C (mean reduction 2.5% at 1 and 2 years). Results demonstrate that in a clinic setting, patients on pump therapy maintain lower A1C values over 1 to 10 years.
Pediatric to AdultsdLessons Learned 4 Years in Transitioning LAILA D. BISHARA*, SHERON PHILLIPS*, TINA HEALEY* Markham, ON Markham Stouffville Hospital adult DEC created a program to help improve young adults transitioning to an adult DEC with the goals of: reducing dropout rate and hospitalizations, fostering independence and surveillance for complicationsdall this through a specific transition team that builds a safe environment. Overall, 40 people were included in the program from 2009 to 2013. Data collected to reflect the program objectives showed the following: 69.5% made their own appointments, 66% monitor glucose > than 2x/day, the majority of testing included 2 hours post-meals. Fifty-nine percent attended more than 3 times a year and corresponded via e-mail. Overall there were 3 admissions for DKA and 1 for hypoglycemia. Dropout rate was 10/40. Mean HBA1C improved in 50% of the patients, did not change in 33% and increased in 17%. Surveillance for complications over 4 years: 33% had dilated eye exams, 60% had screening for nephropathy and lipids. The findings demonstrate that it remains a challenge to maintain these young adults engaged in the program. Continuing glucose monitoring (CGM) is one of the tools that we are currently using to help this group of patients engaged in their care by recognizing the effects of insulin omission, alcohol, exercise and hypoglycemia. More tools such as psycho-social support and new technology are needed to assist in achieving the program objectives.
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Transition in Type 1 Diabetes: Evolution From Childhood To Adulthood in a Unicentric Patient Cohort S. JOHN WEISNAGEL*, MÉLANIE BEAULIEU, MARIE-CHRISTINE DUBÉ Quebec, QC
Incidence of Hyperglycemia and Hypoglycemia Before and After Implementation of a Basal-Prandial-Correctional Insulin Administration Protocol in Hospitalized Patients with Type I or Type II Diabetes GINA MCGRAW*, RÉMI LEBLANC, MARTINE POIRIER, MATHIEU BÉLANGER Moncton, NB
Aim: Factors in the pediatric years that relate to type 1 diabetes control and complications during early adulthood were explored. Methods: Data on body mass index (BMI), HbA1c, insulin therapy, lifestyle, education and employment, complications rate and psychosocial issues was obtained. Results: Medical files from 110 patients with long-term follow up were reviewed (age at diagnosis: 84 years, duration of follow up: 205 years). Eleven (10%) patients had at least one mention of a psychosocial problem at one point in their life. Mean HbA1c peaked at age 13 (HbA1c: 8.961.95), with subsequent improvement (p<0.001). Seventy-one patients (65%) had at least 1 complication of their diabetes: retinopathy (51%), nephropathy (38%), hypertension (10%), neuropathy (5%) and CVD (0.9%). In individuals with good metabolic control at age 10, 50% presented with nephropathy later in life. In individuals with poor metabolic control at age 10, 100% presented with nephropathy, 75% with retinopathy and 50% (p<0.05) with neuropathy later in life. HbA1c was inversely related to BMI in adolescents and adults. Adults with optimal glycemic control presented higher BMI compared to those with moderate glycemic control. Conclusion: There was a significant improvement of HbA1c between the ages of 13 and 30. Poorer control during childhood
Background: In most hospitals, sliding scale insulin (SSI) has been used as the mainstay of hyperglycemia management. This reactive approach has been associated with increased rates of hyperglycemia, hypoglycemia and post-operative complications. Both the Canadian Diabetes Association and the American Diabetes Association now recommend the use of basal, prandial and correction insulin instead of the SSI for in-hospital patients. Objectives: To examine the effect of implementing a basal-prandial-correctional (BPC) subcutaneous insulin therapy protocol on glycemic control in 9 different in-patient units of the Dr. GeorgesL.-Dumont University Hospital Centre (DGLDUHC) in Moncton, NB. Methods: Since 2012, ongoing health education sessions on the rationale, the implementation and the application of the BPC protocol have been delivered to nursing staff, physicians, pharmacists, dieticians and other support staff. Previously written SSI protocols have been replaced with BPC insulin orders. Results: Two months after the implementation of BPC, the incidence of hyperglycemia (CBG10 mmol/L) was reduced significantly in 6 of the 9 units but was increased in 1 unit. The incidence
Abstracts / Can J Diabetes 37 (2013) S13eS84
Results: A1c averages decreased from 10.3% to 8.0% (n¼393); satisfaction survey results found that 97% of patients had an improvement in their ability to self-manage their disease. Conclusions: The CCDC has met first-year program goals, indicating a reduction in risk for complications of diabetes for the majority of enrolled patients. Future plans to increase program efficiencies will be discussed.
seemed to be related to later complications in early adulthood. HbA1c was inversely related to BMI in adolescents and young adults, suggesting a significant impact of management on weight status and obesity risk. Further studies are required to better identify those at risk of future complications.
90 88 Long-Term Glycemic Control in Patients on Insulin Pump Therapy CHRISTINE ORR, WILMA HOPMAN, JOY YEN, ROBYN HOULDEN Kingston, ON Insulin pumps are an effective method of intensive therapy for type 1 DM; however, studies have been <1 year and have not examined longer-term glycemic control. We performed a retrospective analysis of change in A1C in patients on insulin pump >1 year and analyzed factors influencing A1C. A1C values immediately prior to pump initiation and at 3- to 6-month and yearly intervals thereafter were analyzed for 200 patients (123 females, 77 males). Average age at pump initiation was 35.4 years (SD 14.7, range 9 to 76). Average duration of DM prior to pump was 22.4 years (SD 12.4, range 1 to 56). Mean duration of pump therapy was 6 years (SD 3.5, range 1 to 15). Mean A1C at initiation of pump was 8.7 (SD 1.7, range 5.6 to 15.8). Mean A1C initially decreased to a nadir of 7.5 at 3 to 6 months (SD 1.0, p<0.001) and increased over time (range 7.8 to 8.2%) but remained lower than pre-pump A1C (p<0.001). There was no difference in mean A1C between men and women at all durations. Missed appointments were a predictor of higher A1C on pump therapy. Pre-pump A1C predicted long-term A1C on pump therapy. Patients with pre-pump A1C <7% were likely to maintain A1C values in this range. Patients with A1C> 9% showed the greatest decline in A1C (mean reduction 2.5% at 1 and 2 years). Results demonstrate that in a clinic setting, patients on pump therapy maintain lower A1C values over 1 to 10 years.
Pediatric to AdultsdLessons Learned 4 Years in Transitioning LAILA D. BISHARA*, SHERON PHILLIPS*, TINA HEALEY* Markham, ON Markham Stouffville Hospital adult DEC created a program to help improve young adults transitioning to an adult DEC with the goals of: reducing dropout rate and hospitalizations, fostering independence and surveillance for complicationsdall this through a specific transition team that builds a safe environment. Overall, 40 people were included in the program from 2009 to 2013. Data collected to reflect the program objectives showed the following: 69.5% made their own appointments, 66% monitor glucose > than 2x/day, the majority of testing included 2 hours post-meals. Fifty-nine percent attended more than 3 times a year and corresponded via e-mail. Overall there were 3 admissions for DKA and 1 for hypoglycemia. Dropout rate was 10/40. Mean HBA1C improved in 50% of the patients, did not change in 33% and increased in 17%. Surveillance for complications over 4 years: 33% had dilated eye exams, 60% had screening for nephropathy and lipids. The findings demonstrate that it remains a challenge to maintain these young adults engaged in the program. Continuing glucose monitoring (CGM) is one of the tools that we are currently using to help this group of patients engaged in their care by recognizing the effects of insulin omission, alcohol, exercise and hypoglycemia. More tools such as psycho-social support and new technology are needed to assist in achieving the program objectives.
89
91
Transition in Type 1 Diabetes: Evolution From Childhood To Adulthood in a Unicentric Patient Cohort S. JOHN WEISNAGEL*, MÉLANIE BEAULIEU, MARIE-CHRISTINE DUBÉ Quebec, QC
Incidence of Hyperglycemia and Hypoglycemia Before and After Implementation of a Basal-Prandial-Correctional Insulin Administration Protocol in Hospitalized Patients with Type I or Type II Diabetes GINA MCGRAW*, RÉMI LEBLANC, MARTINE POIRIER, MATHIEU BÉLANGER Moncton, NB
Aim: Factors in the pediatric years that relate to type 1 diabetes control and complications during early adulthood were explored. Methods: Data on body mass index (BMI), HbA1c, insulin therapy, lifestyle, education and employment, complications rate and psychosocial issues was obtained. Results: Medical files from 110 patients with long-term follow up were reviewed (age at diagnosis: 84 years, duration of follow up: 205 years). Eleven (10%) patients had at least one mention of a psychosocial problem at one point in their life. Mean HbA1c peaked at age 13 (HbA1c: 8.961.95), with subsequent improvement (p<0.001). Seventy-one patients (65%) had at least 1 complication of their diabetes: retinopathy (51%), nephropathy (38%), hypertension (10%), neuropathy (5%) and CVD (0.9%). In individuals with good metabolic control at age 10, 50% presented with nephropathy later in life. In individuals with poor metabolic control at age 10, 100% presented with nephropathy, 75% with retinopathy and 50% (p<0.05) with neuropathy later in life. HbA1c was inversely related to BMI in adolescents and adults. Adults with optimal glycemic control presented higher BMI compared to those with moderate glycemic control. Conclusion: There was a significant improvement of HbA1c between the ages of 13 and 30. Poorer control during childhood
Background: In most hospitals, sliding scale insulin (SSI) has been used as the mainstay of hyperglycemia management. This reactive approach has been associated with increased rates of hyperglycemia, hypoglycemia and post-operative complications. Both the Canadian Diabetes Association and the American Diabetes Association now recommend the use of basal, prandial and correction insulin instead of the SSI for in-hospital patients. Objectives: To examine the effect of implementing a basal-prandial-correctional (BPC) subcutaneous insulin therapy protocol on glycemic control in 9 different in-patient units of the Dr. GeorgesL.-Dumont University Hospital Centre (DGLDUHC) in Moncton, NB. Methods: Since 2012, ongoing health education sessions on the rationale, the implementation and the application of the BPC protocol have been delivered to nursing staff, physicians, pharmacists, dieticians and other support staff. Previously written SSI protocols have been replaced with BPC insulin orders. Results: Two months after the implementation of BPC, the incidence of hyperglycemia (CBG10 mmol/L) was reduced significantly in 6 of the 9 units but was increased in 1 unit. The incidence