International Society for Pediatric and Adolescent Diabetes
ISPAD 2014 | 40th Anniversary |
249
P161
Insulin treatment and HbA1c in a large paediatric cystic fibrosis clinic
D. Sadie
1
, S. Simmons
2
, C. Judge
1
, M.E. Craig
1,3
, P. Robinson
2,3
, H. Selvadurai
2,3
, D.A. Fitzgerald
2,3
,
S. Towns
2,3
, P. Cooper
2
, K.C. Donaghue
1,3
1
The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Sydney, Australia,
2
The Children's Hospital at Westmead, Department of Respiratory Medicine, Sydney, Australia,
3
University of Sydney, Sydney, Australia
Insulin treatment has been shown to improve body mass index (BMI) and pulmonary function in
dysglycaemia in Cystic Fibrosis but adds to the burden of disease treatment.
Aims:
To characterize insulin dose and regimen, HbA1c and growth in subjects with Cystic Fibrosis
(CF) at The Children's Hospital at Westmead (CHW).
Method:
This study reviewed current insulin requiring subjects with CF (n=28) in a large CF clinic
population (n=211, 103 ≥ 10yrs of age). 8/28 subjects were excluded from analysis due to insulin
refusal (2), not currently requiring (3), transplant (1), newly diagnosed (2). Routine OGTT screening
takes place from age 10yrs. Included were five with Impaired Glucose Tolerance (IGT) and/or 'other'*:
random hyperglycaemia with poor weight gain and/or declining lung function deemed to benefit from
insulin. Insulin dose and regimen, HbA1c, height and BMI SDS were compared in 4 groups: CFRD,
IGT, other causes and T1DM, before and after insulin.
Results:
26 of 103 children > age of 10yrs require insulin (25%). Median age at starting insulin was
13.0 [10.3 - 14.3] yrs. Those classified as T1DM (2 +ve Ab) required more insulin and had higher
HbA1c. There was no statistical difference in growth parameters and insulin doses. Characteristics of
4 groups analysed are shown in table below.
CFRD (n=10)
IGT (n=5)
Other *(n=3)
T1DM(2+veAb´s)
(n=2)
Duration on insulin
(mths)
19.5 [9.9 - 28.1]
25.3 [3.0 - 27.7]
20.0 [10.1 - 23.8] 76.4 [48.8 - 104.0]
Insulin (U/kg/day) 0.114 [0.071 -
0.157]
0.171 [0.171 -
0.184]
0.245 [0.096 -
0.543]
1.149 [0.582 -
1.717]
Basal-bolus vs
basal insulin
1/9
1/4
0/3
2/0
BMI SDS
-0.03 [-0.91 to
0.65]
-0.85 [-1.26 to -
0.24]
0.23 [-0.80 to 0.41] -0.21 [-0.35 to -
0.08]
Height SDS
-0.92 [-1.31 to -
0.58]
-2.19 [-2.92 to -
1.71]
-0.80 [-1.57 to
0.10]
-0.69 [-0.94 to -
0.44]
HbA1c (%)
5.8 [5.7 - 6.0]
5.4 [5.4 - 6.3]
5.7 [5.6 - 6.3]
7.5 [6.7 - 8.3]
[Current characteristics of 4 glycaemic groups]
Conclusion:
Insulin use is common in age group ≥ 10yrs in our CF clinic. Dose and HbA1c were very
similar across CFRD, IGT and 'other' groups. Glycaemic targets for therapy and monitoring may need
modification in this population to maximise benefit from insulin therapy.
