Abstract
Background: Type 1 diabetes (T1D) management requires year-round adherence to treatment regimen. Holidays may present a challenge towards achieving good metabolic control.
Objectives: Our aim was to investigate the effect of holidays on diabetes management of schoolchildren with T1D.
Methods: Observational, case-crossover study of 45 schoolchildren, age range 7–19 years, mean 13.2±3.4 years, followed in a pediatric diabetes clinic. Subjects were stratified by age [<12 years (n=21), >12 years (n=24)] and treatment modality [insulin pump (n=29) or multiple daily injections (n=16)]. Data were downloaded from glucometers and insulin pumps during five non-weekend holidays and five subsequent school days.
Results: The mean number of blood glucose (BG) readings was significantly lower (4.4±1.9 vs. 4.8±1.9, p<0.01) and mean BG marginally higher (11.4±2.7 vs. 10.7±3.1 mmol/L, p=0.1) during holidays than during school days in the entire cohort. Children were significantly more adherent to diabetes management than adolescents as expressed by lower mean glycated hemoglobin level (7.7±0.8% vs. 8.6±1.4%, p<0.05), more BG readings per day (p<0.001) and lower mean BG on holidays (p<0.05) and on schooldays (p<0.01). In pump users, no difference in the mean number of boluses per day and mean insulin units per kilogram per day was observed between holidays and school days.
Conclusions: The management of school-aged children with T1D during holidays was worse than during school days; these finding were more pronounced in adolescents. The diabetes team should be aware of suboptimal therapy during holidays and should consider intervention programs in attempts to educate patients accordingly.
References
1. Channon S, Hambly H, Robling M, Bennert K, Gregory JW. Meeting the psychosocial needs of children with diabetes within routine clinical practice. Diabet Med 2010;27:1209–11.10.1111/j.1464-5491.2010.03071.xSearch in Google Scholar
2. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. New Engl J Med 1993;329:977–86.10.1056/NEJM199309303291401Search in Google Scholar
3. Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group. J Pediatr 1994;125:177–88.10.1016/S0022-3476(94)70190-3Search in Google Scholar
4. Schlundt DG, Pichert JW, Rea MR, Puryear W, Penha ML, et al. Situational obstacles to adherence for adolescents with diabetes. Diabetes Educ 1994;20:207–11.10.1177/014572179402000305Search in Google Scholar PubMed
5. Chen HS, Jap TS, Chen RL, Lin HD. A prospective study of glycemic control during holiday time in type 2 diabetic patients. Diabetes Care 2004;27:326–30.10.2337/diacare.27.2.326Search in Google Scholar PubMed
6. Asplund J. Seasonal variation of HbA1c in adult diabetic patients. Diabetes Care 1997;20:234.10.2337/diacare.20.2.234aSearch in Google Scholar PubMed
7. Chen HS, Wu TE, Jap TS, Chen RL, Lin HD. Effects of health education on glycemic control during holiday time in patients with type 2 diabetes mellitus. Am J Manag Care 2008;14: 45–51.Search in Google Scholar
8. Yan SF, Ramasamy R, Schmidt AM. The RAGE axis: a fundamental mechanism signaling danger to the vulnerable vasculature. Circ Res 2010;106:842–53.10.1161/CIRCRESAHA.109.212217Search in Google Scholar PubMed PubMed Central
9. Ding H, Triggle CR. Endothelial dysfunction in diabetes: multiple targets for treatment. Pflugers Arch 2010;459:977–94.10.1007/s00424-010-0807-3Search in Google Scholar PubMed
10. Mokini Z, Marcovecchio ML, Chiarelli F. Molecular pathology of oxidative stress in diabetic angiopathy: role of mitochondrial and cellular pathways. Diabetes Res Clin Pract 2010;87:313–21.10.1016/j.diabres.2009.11.018Search in Google Scholar PubMed
11. Wang YC, Stewart S, Tuli E, White P. Improved glycemic control in adolescents with type 1 diabetes mellitus who attend diabetes camp. Pediatr Diabetes 2008;9:29–34.10.1111/j.1399-5448.2007.00285.xSearch in Google Scholar PubMed
©2013 by Walter de Gruyter Berlin Boston
