P-141: Beyond HbA1c: impact of therapeutic education and continuous glucose monitoring in pediatric type 1 diabetes

Introduction

Therapeutic patient education (TPE) is central to pediatric type 1 diabetes (T1D) management. Its impact on dynamic glycemic metrics — time in range, variability, and circadian patterns — remains underexplored. This study evaluates the combined effect of structured TPE and continuous glucose monitoring (CGM) with ambulatory glucose profile (AGP) analysis.

Objectives

To assess the effect of structured TPE combined with CGM-based AGP analysis on glycemic outcomes, autonomy, and well-being in pediatric T1D, and to examine the limitations of HbA1c as a standalone metric of glycemic control.

Methods

Observational study conducted at CHU Tlemcen, Algeria, including 11 children and adolescents with T1D (mean age 13.5 ± 2.16 years; mean diabetes duration 7.9 ± 3.04 years). Participants completed three TPE sessions over one year, followed by CGM assessment at 1–3 months post-final session. . Repeated-measures ANOVA was applied.

Results

HbA1c significantly decreased from 11.57% to 9.07% across TPE sessions, reaching 8.2% at CGM assessment (p=0.001). Mean glucose declined from 252.8 to 177.1 mg/dL (p=0.012) with reduced variability. Self-management autonomy improved markedly (urinalysis skills: 2/11 to 9/11 patients). Acute complications decreased progressively. Patient well-being improved significantly (VAS: 7.16 → 3.09; p<0.05).

However, CGM data revealed persistently suboptimal control: mean TIR 37% (target ≥70%), CV 46.4% (target <36%), mean glucose 201 mg/dL. AGP analysis identified individualized glycemic patterns — nocturnal hypoglycemia, postprandial hyperglycemia, avoidance behaviors — enabling targeted insulin adjustments.

Conclusions

TPE combined with CGM and AGP analysis improves glycemic control, autonomy, and well-being in pediatric T1D. The low mean TIR despite improved HbA1c underscores that HbA1c alone is insufficient, and highlights the need for integrated approaches combining CGM analysis, individualized therapy, and psychosocial support — particularly in resource-limited settings.