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Abstract Body

Background and aims

Guidelines on adolescent medicine articulate the importance of active involvement of young people (YP) in their own care and treatment, but the uptake of these recommendations in daily practice remains unknown. This study aims to gain insight into communication processes between YP with type 1 diabetes (T1DM) and professionals during the transition to adult care.

Methods

Semi-structured observations (n=63) of outpatient consultations with YP with T1DM (12-25 years) were performed in 15 Dutch diabetes teams, and included consultations in paediatric care (n=27), adult care (n=19), and joint consultations (n=17). Paediatricians, internists, (paediatric) diabetes nurses, psychologists and dieticians were involved. Data collection focused on communication processes, i.e. whether professionals engaged in open and in-depth conversations, used motivational interviewing techniques, involved YP in shared decision-making, and addressed non-medical topics. Thematic analysis was conducted.

Results

Professionals paid little attention to YP’s individual attitudes and priorities regarding their disease management. Non-medical topics were not systematically addressed. While professionals did ask YP about their daily life, these conversations often remained shallow as professionals did not always follow-up on the replies and signals given. Consequently, decisions made are not supported by the YP which may diminish YP’s motivation to adhere to the recommendations.

Conclusions

To promote quality of care, professionals should gain more insight into YP’s norms, values and priorities regarding their management of T1DM in daily life. Deeper understanding of attitudes and intrinsic motivation may enable professionals to tailor self-management support and treatment recommendations, thereby limiting the risk of unfavourable health outcomes.

Abstract Body

The aim of the study was to analyze the use of glycemic variability (GV) parameters: average amplitude of glycemic excursions (MAGE), standard deviation (SD) and mean area under the curve glucose (AUC) to assess glycemic control in adolescents with type 1 diabetes mellitus (T1DM) treated with continuous subcutaneous insulin infusion (CSII).

64 adolescents with T1DM aged 14-18 years on CSII were monitored with continuous glucose monitoring (CGM) system «Guardian Real Time» (Medtronic) for 3 days. Based on CGM recording patients were divided into 2 groups: group I - 30(46.9%) adolescents who achieved over 70% of the monitoring time target glycemic goals (according to ISPAD 2018); group II - 34(53.1%) subjects with glucose fluctuations over the target.

In group I average HbA1c was 7.5(6.6;8.3)%, average glucose - 6.8(6.5;7.3) mmol/l, SD - 2.5(2.2;2.7)mmol/l; MAGE - 3.5(3.3;4.3)mmol/l, mean AUC - 0.67(0.52;0.87) mmol/l*h. In group II average HbA1c was 8.9(7.6;10.48)%, average glucose - 9.25(8.0;10.0) mmol/l, SD - 3.3(2.6;3.4)mmol/l; MAGE - 5.27(4.2;5.8)mmol/l, AUC - 1.98(1.50;2.72) mmol/l*h. 32.0% of patients in group I, despite the optimal level of HbA1c ≤7.0%, had high glycemic swings, that was confirmed by MAGE, SD, AUC levels. Statistical analyses revealed AUC to be most optimal GV parameter, reflecting glycemic fluctuations, time spent in the hyper- and hypoglycemic ranges.

To assess the glycemic control in adolescents with T1DM on CSII along with HbAlc it is recommended to use the GV parameter - AUC. AUC value ≥1.18 mmol/l*h considered to be a marker of poor glycemic control.