Monitoring the glycaemic profile in children and adolescents with type 1 diabetes
Children with type 1 diabetes should have their blood glucose concentrations checked using a capillary (finger-prick) blood sample at least four times a day, before meals and before bedtime.
Children should attend a specialist diabetes service every 3 months, or every 6 to 8 weeks if they are very young or if their glycaemic targets are not achieved. There is a positive correlation between frequent contact with health professionals and achievement of glycaemic targets.
Growth is a sensitive marker of a child’s wellbeing. Monitoring should include measuring height and weight (and plotting it on centile growth charts), and calculating body mass index (BMI).
Monitoring also includes measuring point-of-care capillary (finger-prick) blood for glycated haemoglobin (HbA1c). Caution is needed in interpreting HbA1c in patients with conditions that affect red blood cell turnover (see Limitations of HbA1c tests).
The recommended HbA1c target for children of all ages is less than 53 mmol/mol (7%). The association between increased rates of severe hypoglycaemia and low HbA1c that was initially seen in the Diabetes Control and Complications Trial (DCCT)1 is no longer apparent. Patients can have a low HbA1c without severe hypoglycaemia occurring, provided there is frequent monitoring of blood glucose concentrations as above. The use of different insulins (eg rapid- and long-acting insulin), and newer blood glucose concentration monitoring devices and monitoring schedules have also possibly contributed to the lower rate of severe hypoglycaemia.
Interstitial fluid glucose monitoring using either continuous glucose monitoring (CGM) or flash glucose monitoring is increasing. However, capillary (finger-prick) blood glucose monitoring must be used along with these methods. Benefits of flash glucose monitoring and CGM depend to some extent on the insulin regimen and the ability of the regimen to respond to blood glucose concentrations with insulin delivery in real time. To confer a metabolic benefit, CGM must be used more than 80% of the time. See information on self-monitoring of blood glucose concentrations, including detail of interstitial fluid glucose monitoring, in Monitoring the glycaemic profile for adults with type 1 diabetes.