DEFINING SUCCESS: REEVALUATING DISEASE MANAGEMENT METRICS IN PEDIATRIC PATIENTS WITH TYPE 1 DIABETES
Embargo until
Date
2020-04-21
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Johns Hopkins University
Abstract
Despite advancements in diabetes devices and management technologies, pediatric patients with type 1 diabetes (T1D) are still struggling to meet standards for glycemic goals. With the inability to appropriately control glucose levels, studies have shown that there are definite increases in diabetes-related complications and potentially life-threatening consequences. Currently, diabetes success is measured by having a hemoglobin A1c (HbA1c) value that is less than or equal to the national target of 7.5%. Recognizing that a disappointing percentage of patients are actually meeting these glycemic targets, researchers have attempted to narrow the gap between patients achieving and not achieving metabolic control. While it has been suggested that the glycemic profile is not being evaluated in its entirety, this thesis project examined the need to integrate other metrics when evaluating a patient’s actual degree of glycemic control and resultant diabetes success.
The project focus was directed to time in range values, rather than HbA1c levels, as a defining outcome of glycemic control. Data was collected on pediatric patients with type 1 diabetes who were using continuous glucose monitoring (CGM). Parameters such as HbA1c levels, time in range, average sensor glucose, scored levels of compliance to six specific self-management behaviors, along with basic demographic information were included in the final data set. The primary relationship between the effect adherence to six self-management habits had on time in range values was closely analyzed.
A final sample size of 654 T1D pediatric patients using CGM were included for review. Results from regression analyses indicated that patients who performed the self-management habits were more likely to have higher time in range values. As patients increased their adherence to the six habits by performing more than one behavior, time in range values also increased. In spite of the promising relationship identified between these two variables, still only 18.8% of the CGM cohort met the current goals for time in range (≥60%). In the same cohort, only 32.9% of patients met the standard HbA1c target. Disproportionate access to CGM may play a role in the statistical findings of this cohort with regard to meeting glycemic targets, as time in range is most easily retrieved from CGM devices when evaluating metabolic control.
Discovering a correlation between time in range and self-management habits is only one of many steps to reevaluate how diabetes success is defined. Combining time in range information with current HbA1c testing could facilitate the development of more realistic management plans for patients with type 1 diabetes. Introducing the importance of time in range and its positive associations with reduced disease-related complications and improved glycemic control is vital to initiate a more encompassing review of diabetes success. Future research is still needed to further investigate the relationship between time in range and compliance with self-management behaviors in a larger population of patients with type 1 diabetes. Having scientific data to support other metrics and methods to aid in disease management could offer patients with type 1 diabetes a new hope for success.
Description
Keywords
Type 1 diabetes, glycemic metrics