Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2016

Suboptimal overnight glucose control behaviours common in adults with Type 1 diabetes: An assessment tool and need for education. (#230)

Alicia J Jenkins 1 2 , Christina Larsson 2 3 , Rachel McGrath 4 , David N O'Neal 1 5 , Johnny Ludvigsson 3 , Richard MacIsaac 5 , Glenn Ward 5 , Gregory Fulcher 4 , Andrzej S Januszewski 1 2
  1. Department of Medicine, University of Melbourne, Fitzroy, VIC, Australia
  2. NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
  3. Department of Pediatrics, Linköping University, Linköping, Sweden
  4. Department of Endocrinology, Royal North Shore Hospital, University of Sydney, St Leonards, NSW, Australia
  5. Department of Endocrinology and Diabetes, St Vincent’s Hospital, Melbourne, VIC, Australia

Introduction: Self-management influences diabetes outcomes and nocturnal glycaemia can be problematic in Type 1 diabetes (T1D).

Aims: To 1) explore adult T1D patient behaviour re overnight glycaemia by 2) developing/using a survey, and 3) describe patient characteristics related to optimal overnight glucose management.

Methods: RNS and SVH Diabetes Clinic T1D patients completed a (10-15 minute, in-clinic paper) questionnaire, including response to six suggested pre-bedtime blood glucose (4-20mmol/l) scenarios. Descriptive analyses, t-tests, Chi-square-tests, ANOVA and logistic regression were performed and significance taken at p<0.05.

Results: Over 90% eligible adults participated, n=205. Mean(SD) age and T1D duration were 41(17) and 20(16) years, with 38% using insulin pumps. Mean(SD) HbA1c was 7.6(1.1)% and 21% had had 1 severe hypoglycaemia in the last year. Mean(SD) blood glucose targets overnight, bedtime and daytime were 7.1(1.3), 7.5(1.4) and 6.7(1.0)mmol/l respectively. Mean(SD) blood glucose tests/day were 5.4(2.7), with 73% testing regularly at bedtime; 9% testing overnight daily, and 7% and 27% never testing pre-bed and overnight respectively. Most (68%) subjects treated a nocturnal hypo with rapid-acting carbohydrate only and only 44% retested glucose soon after. Thirty-one percent did not have ketone test-strips.

Only 28% made safe choices in all bedtime glucose scenarios. Optimal behaviour was associated with: (i) pump use (68% less, p=0.0005); (ii) frequent glucose testing (tests/day, at bedtime/week, overnight testing) lowered odds for suboptimal behaviour by 15%, 14% and 63% respectively (all p<0.05); and (iii)  1mmol/l lower bedtime glucose target (44% less, p=0.008). Suboptimal behaviour was 3.5-fold higher in those not retesting glucose till morning after a nocturnal hypo, p=0.0002. After extra exercise, alcohol or illness 48%, 46% and 47% (respectively), would not change their overnight care-plan. Thirty-two percent desired education.

Conclusion: Most T1D adults have behaviours placing them at risk of suboptimal overnight glycaemia. A survey, such as used herein, may identify at-risk patients.