Achieving target levels for vascular risk parameters in Polish school-age children with type 1 diabetes - a single center study

Background: Therapeutic goals have been established to decrease the risk of long-term complications of type 1 diabetes (T1DM). The effects of these guidelines should be constantly evaluated. Hence, the present study examines the frequency at which children with T1DM treated by one of the Polish reference centers complied with the therapeutic targets issued in 2014 by the International Society for Pediatric and Adolescent Diabetes (ISPAD) and by the Diabetes Poland (PTD). Methods: A retrospective analysis (years 2011-2014) was performed in patients with T1DM aged 6.5-18 years, with diabetes duration >12 months and no change of insulin regimen within 6 months. Collected data included insulin therapy regimen, weight, height, blood pressure, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and glycated hemoglobin (HbA(1c)) level from the last hospitalization. Results: The records of 447 patients (260 boys, 299 treated with insulin pump) were analyzed. All ISPAD goals were achieved by 123 (27.5%) patients, but only 43 (9.6%) met all PTD targets. Optimal HbA(1c) was achieved by 224 (50.1%) according to ISPAD criteria (HbA(1c) <7.5%) and by 87 (19.6%) patients according to PTD (HbA(1c) <= 6.5%). Obesity was diagnosed in 11.6% of the patients; 19.7% of the patients were overweight. In logistic regression, patient age was the only independent predictor of failing to achieve complete T1DM control (p = 0.001, OR = 1.12 [1.05-1.23]) and optimal HbA(1c) (p = 0.01, OR = 1.1 [1.0-1.2]) according to ISPAD guidelines. Moreover, girls had a greater risk of failing body mass index (BMI) targets (PTD: p = 0.002, OR = 2.16; ISPAD: p = 0.0001, OR = 3.37) and LDL-C targets (p = 0.005, OR = 1.8) than boys. Conclusions: Overall, control of vascular risk factors in Polish children with T1DM is unsatisfactory. While too few children are achieving the HbA(1c) target set by PTD, it is possible that such strict national target helps half of the Polish school-age patients achieve ISPAD-issued aim which is more liberal. High prevalence of overweight among children with T1DM warrants initiatives focused not only on glycemic control but also on motivation of patients to lead a healthy lifestyle.