Introduction: In 2004, with the release of DCCT/EDIC trial results, we resolved to intensify therapy in all children (not just adolescents) with type 1 diabetes, from diagnosis. This had to be achieved within current resources and with stable or reduced incidence of severe hypoglycaemia and DKA. At the time there were few children using intensive insulin therapy and our clinic average HbA1c was suboptimal (8.4%).
Aim: To introduce intensified insulin therapy, that was flexible, acceptable to ward staff, catering staff and RMOs and easily adopted by families.
Method: We implemented two novel approaches; the ezyBICC © multiple daily injection (MDI) system and the SPIN pump program. The primary focus of these programs was to simplify complex concepts and deliver consistent messages and methods across the health care service assisting families to learn the principles rapidly and to integrate them into day to day life. A database was established to audit outcomes and identify management issues.
Results: The clinic average HbA1c fell to 7.8% within 18 months and has ranged from7.40-7.55% since 2010, one of the lowest of any paediatric diabetes clinic in Australia (1) and internationally, Hvidore study (2).The ezyBICC © system has been applauded by all stakeholders and is now used by many regional diabetes units in NSW and interstate. There has been a 30 to 40 % uptake of insulin pump therapy. The rate of severe hypoglycaemia and DKA has decreased. 453 patients have completed the program.
Conclusion: We have successfully developed and implemented novel approaches to optimise diabetes management in children and adolescents. We have achieved this without any enhancement to already constrained resources. We have continually evaluated and refined our programs in response to the needs of our families and will continue to work with our clients to help them achieve their full potential.