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Abstract
Objective To examine the impact of multidisciplinary team input and intensive insulin therapy on glycaemic control in children and adolescents with diabetes over a 13-year period.
Design Two statistical approaches were used to interrogate the dataset. First a matched pair analysis to compare insulin treatment-type effect (pump vs multiple daily injections (MDIs)), followed by panel data regression to assess the impact of intensive re-education on glycated haemoglobin (HbA1c), in addition to treatment type.
Setting A large tertiary paediatric diabetes centre using a prospectively maintained database of clinical encounters from 2007 to 2020.
Main outcome measures Difference in HbA1c between treatment types (matching methodology) and expected change in HbA1c with treatment type and re-education (panel data).
Results Compared with MDI, matched pump patients had a lower HbA1c 6 months after pump commencement (ΔHbA1c=-0.53%, CI -0.34% to -0.72%; n=106). This effect was robust in controlling for socioeconomic deprivation (ΔHbA1c=-0.74%, CI -0.40% to -1.08%; n=29). Panel data analysis demonstrated a -0.55% reduction in HbA1c with pump therapy compared with MDI therapy (CI -0.43% to -0.67%). Patients who had intensive re-education had recorded an HbA1c of 0.95% (CI 0.85% to 1.05%) greater than otherwise identical patients prior to re-education. Following these sessions, HbA1c dropped by a mean -0.81% (CI -0.68% to -0.95%) within 6 months. These were also robust in controlling for socioeconomic factors.
Conclusions Compared with matched peers on MDI regimens, patients on pump therapy have lower expected HbA1c, an effect sustained for up to 8 years. Intensive re-education is associated with a significant drop in previously elevated HbA1c levels.
- Paediatrics
- Endocrinology
- Statistics
Data availability statement
Data are available upon reasonable request.
Statistics from Altmetric.com
Data availability statement
Data are available upon reasonable request.
Footnotes
Contributors JF: initial research proposal, data processing, statistical analysis including coding, formatting, interpreting and presenting statistical results, and primary authoring of first draft of paper. AE: clinical nurse specialist, primary designer of the active intervention programme, and contributed to design of project and drafting of the written article. ES: diabetes database management, collection and preparation of data for study, including addition of historical data corrections, input on research design and contribution to written article. SMO’C: refinement of research proposal and design, conducted literature review as part of the drafting process, co-ordination of work between team members, and significant redrafting or original draft with ongoing input. JF is the guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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