Impact of a Diabetes Camp on Glycemic Control Among Children and Adolescents Living With Type 1 Diabetes in Cameroon
Condition: Type 1 Diabetes
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 1
Study type: Interventional

Summary: 
      Therapeutic education is central to the management of diabetes, especially in children and
      adolescents. Camps represent an ideal environment for education. During camps, the campers
      receive both theoretical and practical information intended to improve their understanding
      and self-management of diabetes. The metabolic impact of diabetes camp is little known among
      children and adolescents living with type 1 diabetes in sub-Saharan Africa. The aimed of this
      study was to assess the changes in glycemic control and insulin doses in a group of children
      and adolescents living with type 1 diabetes in Cameroon during and after camp.
    

Detailed description: 
      Participants and setting:

      In this study, the investigators analyzed the data of children and adolescents living with
      type 1 diabetes in Cameroon who attended the diabetes camp organized in Yaoundé in July 2013
      and who came back for follow up at the CDiC clinic of the Yaoundé Central Hospital, 3 and 12
      months later.

      The "Changing Diabetes in Children" (CDiC) project offers logistics and free medical care to
      children living with type 1 diabetes in Cameroon, which includes free medical consultations,
      insulin, syringes, a glucose meter (Accu Check Active®, Roche Diagnostics GmbH, Mannheim,
      Germany) glucose strips, HbA1c monitoring every 3 months, collective therapeutic education
      sessions every 3 months and a yearly screening for complications. All children enrolled in
      the project have a systematic visit every three months. During this visit, clinical and
      biological assessment are done, also adjustment of treatment, therapeutic education and
      record of data in the medical record. Many children also consult outside systematic visits to
      collect the material for treatment or in case of an emergency related or not with diabetes.
      The forms of insulin available in the project are regular insulin (Actrapid®),
      intermediate-acting insulin (Insulatard®) and pre-mixed insulin (Mixtard 30®). HbA1c is
      assessed by the in2it™ point-of-care system (Bio-Rad Laboratories, Deeside, UK).

      The CDiC program organizes a 5-day camp for about 50 children twice yearly. Participants are
      selected by the health care personnel who follow them, based on the availability of places
      and on the proximity to their homes. Children of less than 6 years old, those with an acute
      disease and those with incomplete recovery from a previous illness are not allowed to camp.

      Camp organization:

      A written informed consent was obtained from parents or guardians before inclusion and a
      medical insurance was contracted for campers and the camp staff. The camp staff was made of a
      pediatric endocrinologist, an adult endocrinologist, 3 general physicians, 4 nurses, a
      dietician and a sport coach. The leisure program during the camp included education
      workshops, games, sporting activities, a visit to an animal reserve and a dinner in a
      restaurant in town. Meals offered to the children attending the camp were prepared following
      the instructions of the dietician.

      Treatment protocols and insulin doses of each camper were maintained upon arrival. However,
      during the camp and before every meal, the dose of insulin to be injected was analyzed and
      eventually modified by the physician based on the results of self-monitoring of blood
      glucose, the quantity of carbohydrates to be ingested, and the level of physical activity to
      be performed. Notwithstanding, the treatment protocols could still be modified for some
      camper who were poorly controlled.

      At the end of camp, a prescription was done for every campers and an adjustment of doses was
      made based on capillary glucose. Capillary glucose was measured six times a day (Before and 2
      hours after the 3 main daily meals), and as needed (Before and after an intense physical
      activity, and in case of a symptoms suggestive of hypoglycemia). Finally, all information on
      each camper (injected insulin doses, capillary blood glucose, HbA1c, weight and eventual
      malaise) were recorded in a self-monitoring booklet by the camper always under supervision of
      a camp staff.

      Post-camp data collection Campers were later on routinely followed at the CDiC clinic of the
      Yaoundé Central Hospital. Of the 46 patients who attended the camp, only 32 who came for
      follow up 3 and 12 months later were included in further analyses. Data on age, gender,
      duration of diabetes, duration of follow up in the CDiC project, weight, insulin regimen and
      insulin doses at the beginning, at 3 and 12 months after camp, HbA1c at the beginning, at 3
      and at 12 months after camp, and the daily number hypoglycemic episodes during camp were
      collected. Good glycemic control was defined as HbA1c <7.5% and hypoglycemia as capillary
      glucose < 70mg/dl.

      Data analysis Data were analyzed using the Statistical Package for Social Sciences version 12
      (SPSS Inc. Chicago, IL USA). Results are presented as mean and standard deviation or median
      [interquartile range] for continuous variables and as count (percentage) for discrete
      variables. Proportions were compared by the Z test for two proportions, means by repeated
      measure ANOVA, paired t test or independent t test where appropriate and medians by the
      Wilcoxon rank sum test. Where necessary continuous variables were categorized using the
      median as cutoff. A p-value < 0.05 was used to characterize statistically significant
      results.

      Ethical considerations Prior to enrolment in the CDiC project, a written informed consent
      form was signed by the parent or guardian authorizing the CDiC project in Cameroon to use the
      data obtained for research. A written informed consent was also obtained from parents or
      guardians before enrolment in camp. The CDiC project has also received approval from the
      National Ethics Committee of Cameroon (Autorisation N 271/CNE/SE/2011) to carry out research
      from data obtained in the project.
    

Intervention name(s): Insulin
Intervention type(s): Drug
Intervention description(s): Monitoring insulin therapy of campers based on their usual regimen (one of the following):
premixed insulin in the morning and evening,
premixed insulin in the morning, regular insulin in the afternoon and premixed insulin in the evening,
regular insulin in the morning and afternoon, and premixed insulin in the evening.
Education of campers on different aspects of diabetes care:
monitoring of blood glucose
injection of insulin
adaptation of insulin doses according to blood glucose and during exercise
correction of hypoglycemia
dietary advice
Other intervention name(s): regular, NPH and premixed insulin
Intervention MeSH terms: Insulin; Insulin, Globin Zinc
Intervention model: Single Group Assignment
Masking: None (Open Label)
Keywords: Type 1 diabetes; children; diabetes camps; glycemic control