The choice of insulin regimen and target of glycemic control in children with type 1 diabetes mellitus : -A comparative study of Canada and Norway

Abstract

Abstract

Background Diabetes mellitus (DM) is a group of metabolic diseases characterized by chronic hyperglycemia. Type 1 diabetes mellitus (T1DM) is one of the most common endocrine and metabolic conditions in childhood, rapidly increasing in incidence and associated with increased long-term morbidity and mortality. Optimal diabetes management to avoid or delay the long-term complications of diabetes is important. Diabetes education remains a cornerstone in this work, in addition to optimal diabetes treatment, glycemic control and avoidance of the short-term complications of diabetes while screening for complications and the associated comorbidities.

Aims The aim of this thesis is a comparative study of Norway and Canada, focusing on the choice of target of glycemic control and insulin regimen in treatment of T1DM in children. Methods This thesis consists of two parts; Part one is a literature review on T1DM based upon a non-systematic search in PubMed. Part two is the clinical part of our thesis. We made an electronic questionnaire based on international guidelines and performed a combined survey and interviews in addition to our clinical experiences visiting hospitals in Norway (Oslo University Hospital (OUS)) and Canada (British Columbia Childrens’s Hospital (BCCH) and Hospital for Sick Children (SickKids)).

Results Performing our comparative study of Norway and Canada we found that management of childhood T1DM had many similarities in terms of diabetes management, e.g. diabetes education and composition of the multidisciplinary team. Some differences between the nations and hospitals exist in guidelines, management at the time of diagnosis, hospital admittance, frequency of follow up, choice of insulin regimen and target of glycemic control. While every child diagnosed with T1DM at OUS is offered to start with an insulin pump at diagnosis, all the children at SickKids are started on insulin injection therapy. The two Canadian hospitals both preferred to wait with pump therapy. Approximately two thirds of the Canadian patients were on conventional regimens, compared to almost none at OUS. Both Canadian Hospitals had age-adjusted HbA1c targets that were higher than OUS for the children less than 12 years of age.

Conclusion Optimal diabetes management to avoid short- and long-term complications is important. Children with T1DM should, where possible, receive the best diabetes care available. The hospitals we visited in Norway and Canada all had well-organized diabetes care, mostly according to international guidelines of pediatric diabetes. Tight glycemic control and intensive insulin regimen has been shown to reduce and delay the diabetes late complications and should be included as part of the management of childhood diabetes.