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NEW research has revealed that fewer than one-third of children and adolescents with type 1 diabetes are meeting recommended targets for glycaemic control, as a leading expert renews calls for improved awareness and a greater resource investment.
Professor Maria Craig, paediatric endocrinologist at the Children’s Hospital at Westmead, told MJA InSight that more resources were urgently needed in paediatric diabetes centres to keep up with demand and improve diabetes management in young people.
“Here at the Children’s Hospital at Westmead, we now have no psychologist as part of the diabetes team. The ability to provide the psychological support is limited, and other members of the multidisciplinary team, such as diabetes educators, also struggle with resources.
“The chronic, pervasive nature of this condition needs more awareness among policymakers.”
Professor Craig co-authored the research, published in the MJA, which was based on a cross-sectional analysis of data from the Australasian Diabetes Data Network (ADDN) registry.
The data came from five paediatric diabetes centres in NSW, Queensland, South Australia, Victoria and Western Australia. The 3279 children and adolescents included in the study had been living with type 1 diabetes for at least 12 months.
The mean age of the participants was 12.8 years, and 33% of the participants were overweight or obese. Their mean haemoglobin A1c (HbA1c) level was 67 mmol/mol and only 27% of participants achieved the national HbA1c target of less than 58 mmol/mol. The mean HbA1c level was lower in children under 6 years (63 mmol/mol) than in adolescents (69 mmol/mol).
“It is worrying that less than one-third of Australian children and adolescents with diabetes type 1 met the recommended target for glycaemic control, and that rates of being overweight or obese were higher than in the general Australian population of children and adolescents,” the authors wrote.
They also wrote that the ADDN project had shown that benchmarking glycaemic control, use of insulin therapies, and anthropometry across Australian childhood diabetes centres was feasible.
“As the ADDN registry grows, so will its ability to explore and understand the factors that influence clinical outcomes for Australian children and adolescents, supporting our aim of continually appraising and improving the diabetes services we provide.”
Professor Craig said that the results had key implications for primary care.
“It’s really important for GPs to be aware of what a complex disease this is. They need to be part of the multidisciplinary management team for these patients.”
She said that the article sent out an important message about the struggle with type 1 diabetes – that there are “fantastic” treatments and technologies available, but that the problem was the scale of the disease burden.
“GPs need to continue to be opportunistic, and aware of diabetes and what to look out for in patients.”
In an accompanying editorial, paediatric endocrinologist Dr Mark Sperling wrote that these results provided a snapshot of paediatric diabetes in Australia, and that clear goals, uniform practices, and expectations could influence outcomes for young people with diabetes.
“Almost one in five children were receiving twice-daily insulin injections; the disparity between the various centres in the prevalence of this approach probably reflects local preferences more than the accommodation of patients’ needs,” he wrote.
Dr Sperling said that the research pointed to the need and feasibility for harmonising data collection, for identifying deficiencies in treatment, seeking more resources when appropriate, and implementing more uniform treatment strategies across centres.
In their article Professor Craig and her co-authors cited the use of insulin pumps as a treatment strategy.
“When used with sensors, insulin pumps do improve control,” Professor Craig told MJA InSight.
She said that during the 2016 federal election campaign, the government pledged $54 million towards glucose monitoring technology, which included sensors.
Professor Craig said that one way sensors and pumps could help improve diabetes management was by addressing hyperglycaemia that arose from the fear among parents of their child becoming hypoglycaemic.
She said that accessibility to sensors and insulin pumps needed to be increased nationwide.
“All patients need to be able to access this – not just those with private health insurance. There is no one solution to this problem. It’s a combination of having access to diabetes management, but also access to health resources.”
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Anonymous. The majority of type 1 diabetes occurs in childhood. The majority of children drink milk (albeit, at a progressively declining level). Milk is child-beneficial in a multitude of ways. The incidence of Type 1 diabetes in Australia is one child in 10,000. Mostly they have a polymorphism which makes them susceptible to type 1 diabetes. Therefore, only a very small proportion of children who drink milk are susceptible to contracting type 1 diabetes. It is not particularly logical to exclude milk drinking to all children on the basis of a 1 in 10,000 lifetime risk of getting type 1 diabetes from any cause. A more logical approach would be the early genetic testing of children. The small number with this polymorphism could be restricted in their milk intake.
As for diets. The scientific community are divided between high fat and low fat diets. That aside, milk appears protective against a host of chronic diseases, including metabolic syndrome diabetes, cardiovascular disease, stroke, colorectal cancer, breast cancer (most cancers except prostate cancer), cognitive decline, asthma, obesity, dental caries. References provided if requested. In particular, CLA in milkfat of grass-fed cows appears particularly protective. I will provide just a few references for diabetes:
Diabetes – low-fat yoghurt reduces the risk of developing type-2 diabetes almost a third – Cambridge University study – http://www.smh.com.au/lifestyle/diet-and-fitness/lowfat-yoghurt-may-reduce-diabetes-risk-20140206-3237t.html
https://www.ncbi.nlm.nih.gov/pubmed/20534409
30% reduced risk of diabetes at the highest consumption level of dairy product – https://www.ncbi.nlm.nih.gov/pubmed/19571167
The first goal must be to prevent type 1 diabetes in the first place. There is sufficient evidence to eliminate type 1 diabetes now.
Levy-Marchal, C., Karjalainen, J., Dubois, F., Karges, W., Czernichow, P., Dosch, H.M., 1995. Antibodies against bovine albumin and other diabetes markers in French children. Diabetes Care 18, 1089–1094.
Dahl-Jorgensen, K., Joner, G., Hanssen, K., 1991. Relationship Between Cows’ Milk Consumption and Incidence of IDDM in Childhood. Diabetes Care 14, 1081–1083.
Saukkonen, T., Savilahti, E., Vaarala, O., Virtala, E.T., Tuomilehto, J., Akerblom, H.K., The Childhood Diabetes in Finland Study Group, 1994. Children With Newly Diagnosed IDDM Have Increased Levels of Antibodies to Bovine Serum Albumin But Not to Ovalbumin. Diabetes Care 17, 970–976.
Karjalainen, J., Martin, J., Knip, M., Ilonen, J., Robinson, B., Savilahti, E., Akerblom, H.K., Dosch, H.-M., 1992. A Bovine Albumin Peptide as a possible trigger of insulin-dependent Diabetes Mellitus. New England Journal of Medicine 302–307.
Bachmann, O.P., Dahl, D.B., Brechtel, K., Haap, M., Maier, T., Loviscach, M., Stumvoll, M., Claussen, C.D., Schick, F., Ha, H.U., Jacob, S., 2001. Effects of Intravenous and Dietary Lipid Challenge on Intramyocellular Lipid Content and the Relation With Insulin Sensitivity in Humans. Diabetes 50, 2579–2584.
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The current popularity of low-carbohydrate, high fat diets for treating either type 1 or 2 is misinformed. As James Anderson and colleges noted:
High-carbohydrate, high-fiber diets providing 55% to 60% of energy as carbohydrates, 15% to 20% as protein, and 20% to 25% as fat and including 50 gm or more fiber daily hold the most potential for long-term use. These diets reduce insulin requirements, improve glycemic control, lower fasting serum cholesterol and triglyceride values, and promote weight loss. Studies show good long-term adherence with these diets. Dietitians assume primary responsibility for educating individuals on the benefits and use of high-carbohydrate, high-fiber diets. Diets must be individualized, with special modifications for obesity, hyperlipidemia, or physiological states such as pregnancy and lactation. Widespread use of high-fiber diets will ultimately improve metabolic control and decrease health care costs for thousands of diabetic and non-diabetic individuals.
Anderson, J., Gustafson, N., Bryant, C., Tietyen-Clark, J., 1987. Dietary fiber and diabetes: a comprehensive review and practical application. Journal of the American Dietetic Association 87.
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This applies to both type 1 and type 2 diabetes.
What research is used to justify low-carbohydrate diets – that is not funded by Robert F Atkins Foundation?
Do you think it’s time to address the current high carbohydrate diet advice that is standard for type 1 diabetics? it just doesn’t make sense. The evidence is mounting for type 1s on lower carbohydrate diets having reduced insulin requirements, less hypos and better HBA1cs. We need a well designed government funded trial and we need it now.