An Audit of Clinical Practice in a Single Centre in Kuwait: Management of Children on Continuous Subcutaneous Insulin Infusion and Cardiovascular Risk Factors Screening



Dina Omar*, Hala Alsanae, Mona Al Khawari, Majedah Abdulrasoul, Zahraa Rahme, Faisal Al Refaei, Kazem Behbehani, Azza Shaltout
Dasman Diabetes Institute, Al-Amiri Hospital, Faculty of Medicine, University of Kuwait, Kuwait, Kuwait


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© 2017 Omar et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the P. O Box 1180, Dasman Diabetes Institute, Al-Amiri Hospital, Faculty of Medicine, University of Kuwait, Kuwait; Tel: +965 222 429 99, Fax: +965 222 42971 Email: dina.omar@dasmaninstitute.org


Abstract

Objectives:

To audit the current clinical practice of continuous subcutaneous insulin infusion (CSII) for the treatment of type 1 diabetes mellitus (T1D) in children and adolescents attending a single centre in Kuwait.

Methods:

A one year retrospective audit was performed in children and adolescents with T1D on CSII, who attended the paediatric diabetes clinic, Dasman Diabetes Institute during 2012. The primary outcome measure was glycaemic control as evidenced by glycated haemoglobin (HbA1c) level and the secondary outcome measures were the frequency of monitoring of the risk for microvascular complications and occurrence of acute complications and adverse events.

Results:

58 children and adolescents (mean age ± SD: 12.6 ± 4.1 years) were included. Mean HbA1c at baseline was 8.8% (72.7 mmol/mol) and 8.9% (73.8 mmol/mol) at the end of a 12 months observation period. Children with poor control (HbA1c >9.5% (80 mmol/mol) had a significant 1.4% reduction in HbA1c compared with the overall reduction of 0.1% (p=0.7). Rate of screening for cardiovascular risk factors and for long term complications were well documented. However, there was underreporting of acute complications such as severe hypoglycaemia and diabetic ketoacidosis. Only 1.7% of patients discontinued the pump.

Conclusion:

There was no significant change in HbA1c values at the end of 12 months follow up. However, HbA1c values in poorly controlled children improved. CSII requires care by skilled health professionals as well as education and selection of motivated parents and children.

Keywords: Audit, Continuous subcutaneous insulin infusion, Diabetes pump therapy, Hypoglycaemia, Diabetes Control and Complications Trial (DCCT), Glycated haemoglobin (HbA1c), Type 1 diabetes mellitus.