High day-to-day glucose variability:: A frequent phenomenon in children and adolescents with type 1 diabetes attending summer camp

Background. - Day-to-day glucose variability may cause difficulty for patients trying to adjust their insulin dosages and for healthcare providers when they have to make recommendations. The aim of this research was to evaluate the frequency of high variability in a population of diabetic children and adolescents attending summer camp. Methods and Results. - The mean of the daily differences (MODD) in glucose concentrations was calculated from continuous glucose monitoring (CGM) over five consecutive days in 6 diabetic patients. This index was correlated to the MODD calculated from pre-meal and bedtime blood glucose (BG) measurements (r=0.87). We used the MODD calculated on these four BG measurements for five consecutive days to evaluate day-to-day glucose variability in 100 young diabetic patients treated with glargine and ultrarapid analogue insulin. Only one child had a MODD value lower than 36 mg/dl, considered a threshold for high day-to-day variability, and 94 children had a MODD value higher than 45 mg/dl. The median value was 78 mg/dl. The expected positive correlation between the MODD and its standard deviation (r=0.32, P < 0.01) suggested that the greater the day-to-day variability, the more variable the variability across five consecutive days. Conclusions. - The estimation of MODD from four pre-meal BG values correlated to that from CGM, and may represent a simple index of day-to-day glycaemic variability. High day-to-day glucose variability in glucose profile is frequently observed in diabetic children attending summer camp. (C) 2008 Published by Elsevier Masson SAS.