Temporal trends in the treatment of pediatric type I diabetes and impact on acute outcomes

Objective To evaluate temporal trends in pediatric type 1 diabetes (T1DM) management and resultant effects on outcomes. Study design Two pediatric T1DM cohorts were followed prospectively for 2 years and compared; Cohort 1 (N = 299) was enrolled in 1997 and Cohort 2 (N = 152) was enrolled in 2002. In both cohorts, eligible participants were identified and sequentially approached at regularly scheduled clinic visits until the target number of participants was reached. Main outcome measures were hemoglobin A1c (A1c), body mass index Z score and incidence rate (IR; per 100 patient-years) of hypoglycemia, hospitalizations, and emergency room (ER) visits. Results At baseline, Cohort 2 monitored blood glucose more frequently than Cohort 1 (>= 4 times/day: 72% vs 39%, P < .001) and was prescribed more intensive therapy than Cohort 4 (>= 3 injections/day or pump: 85% vs 65%, P <.001). A1c was lower in Cohort 2 than Cohort 1 at baseline (8.4% vs 8.7%, P = .03) and study's end (8.7% vs 9.0%, P = .04). The cohorts did not differ in Z-BMI (0.83 vs 0.79, P = .57) or IR of hospitalizations (11.2 vs 12.9, P = .38). Cohort 2 had lower IR of total severe hypoglycemic events (29.4 vs 55.4, P < .001) and ER visits (22.0 vs 29.3, P = .02). Conclusions T1DM management intensified during 5 years between cohorts and was accompanied by improved A1c and stable Z-BMI. Along with improved control, IR of severe hypoglycemia and ER visits decreased by almost 50% and 25%. respectively.