Observational study of diabetes management in type 1 diabetic school-age children during holiday versus school days

Background: Type 1 diabetes (T1D) management requires year-round adherence to treatment regimen. Holidays may present a challenge towards achieving good metabolic control. Objectives: Our aim was to investigate the effect of holidays on diabetes management of schoolchildren with T1D. Methods: Observational, case-crossover study of 45 schoolchildren, age range 7-19 years, mean 13.2 +/- 3.4 years, followed in a pediatric diabetes clinic. Subjects were stratified by age [<12 years (n=21), >12 years (n=24)] and treatment modality [insulin pump (n=29) or multiple daily injections (n=16)]. Data were downloaded from glucometers and insulin pumps during five non-weekend holidays and five subsequent school days. Results: The mean number of blood glucose (BG) readings was significantly lower (4.4 +/- 1.9 vs. 4.8 +/- 1.9, p<0.01) and mean BG marginally higher (11.4 +/- 2.7 vs. 10.7 +/- 3.1 mmol/L, p=0.1) during holidays than during school days in the entire cohort. Children were significantly more adherent to diabetes management than adolescents as expressed by lower mean glycated hemoglobin level (7.7 +/- 0.8% vs. 8.6 +/- 1.4%, p<0.05), more BG readings per day (p<0.001) and lower mean BG on holidays (p<0.05) and on school-days (p<0.01). In pump users, no difference in the mean number of boluses per day and mean insulin units per kilo-gram per day was observed between holidays and school days. Conclusions: The management of school-aged children with T1D during holidays was worse than during school days; these finding were more pronounced in adolescents. The diabetes team should be aware of suboptimal therapy during holidays and should consider intervention programs in attempts to educate patients accordingly.