A pilot study to stabilize normoglycemia during an educational camp for children and adolescents with type 1 diabetes mellitus

Abstract

Background: Children and adolescents with type 1 diabetes mellitus (DM) who participate in diabetes camps do not often achieve stable, normoglycemic control, largely because changes in the campers' activity levels and food options necessitate adjustments to their insulin use and nutritional therapies. It would seem logical, with the abundance of diabetes education and professional consultation freely available at these camps, that the glycemic levels of these young campers could approach normal values.

Objective: This informal study was designed to explore the feasibility of safely achieving stable, short-term normo-glycemic control in children and adolescents with recent-onset type 1 DM attending a diabetes camp.

Methods: A multidisciplinary team worked with children and adolescents 6 to 18 years of age during a residential 3-day/2-night diabetes camp. Demographic data were compiled from the application forms completed by the campers and signed by the campers and their parents. The staff functioned in 2 distinct roles: as managers (securing time, task, technique, and territory boundaries) and as consultants (addressing participants' educational, social, and emotional needs). The staff supported the campers in their attempts to quickly and safely achieve tight normoglycemic control (ie, 71–99 mg/dL) and stability (ie, an estimated mean amplitude of glycemic excursion [eMAGE] score ≤95) through their firsthand experience with self-directed learning methods, basal-bolus insulin analogue therapy, and a diet low in concentrated carbohydrates (CHOs). Campers chose foods from meal buffets, calculated preprandial and complementary doses of ultra-rapid insulin, and participated in physical exercise and self-monitoring of blood glucose (SMBG) at will. SMBG values retained in each camper's combined glucose/ketone monitor furnished statistical data. Initial and final glycosylated hemoglobin values were not measured because 3 days of glycemic control—at any BG level—would not be expected and have not been reported to produce significant changes. No follow-up of the campers was planned or possible.

Results: Six boys and 3 girls (aged 8–17 years; mean [SD] age, 11.8 [2.6] years; mean duration of diabetes, 1.62 [0.88] years) agreed to participate in the study. All but 1 of the campers were preadolescents. Mean BG levels on arrival and departure were 209 (101.5) and 81 (12.8) mg/dL, respectively (P < 0.003). The mean 3-day BG level was 95 (21.2) mg/dL. The 3-day mean eMAGE score (66.5 [28.1]) indicated stable glycemic control. Seven of the 9 campers (78%) returned to the camp the following year (2007).

Conclusions: Combining self-directed educational methods for learning diabetes self-management with insulin analogues in a basal-bolus therapy regimen, ad libitum physical activity and SMBG, and a diet low in concentrated CHOs, campers rapidly established routinely normal daily mean BG levels and glycemic stability.