Improving glycaemic control in children and adolescents presents unique problems
Type 1 diabetes affects one in 500 children and adolescents, and vascular complications remain a major cause of mortality and morbidity in adult life. Blood glucose targets have fallen since confirmation of the unequivocal relationship between glycaemic control and microvascular complications.1,2 In this issue of the Journal (page 235), Craig et al present a population-based, cross-sectional study of 1190 children and adolescents with type 1 diabetes in New South Wales and the Australian Capital Territory.3 Their median HbA1c level of 8.2% probably reflects some selection bias, because 571 (33%) of the population did not participate. However, this level of glycaemic control still represents a considerable improvement over the past 10 years4 and is comparable to levels found in international studies of children with type 1 diabetes.5 This trend accompanies the increasing use of intensive management in children and adolescents, but also the worrying rise in the incidence of severe hypoglycaemia.
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- Women's and Children's Hospital, North Adelaide, SA.
- 1. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977-986.
- 2. Couper JJ, Jones TW, Donaghue KC, et al. The Diabetes Control and Complications Trial: Implications for the child and adolescent. Med J Aust 1995; 162: 369-372.
- 3. Craig ME, Handelsman P, Donaghue K, et al for the NSW/ACT HbA1c Study Group. Predictions of glycaemic control and hypoglycaemia in children and adolescents with type 1 diabetes from NSW and ACT. Med J Aust 2002: 177; 235-238. <eMJA full text>
- 4. Davis EA, Keating B, Byrne GC, et al. Impact of improved glycaemic control on rates of hypoglycaemia in insulin dependent diabetes mellitus. Arch Dis Child 1998; 78: 111-115.
- 5. Danne T, Mortensen HB, Hougaard P. et al Persistent differences among centres over 3 years in glycaemic control and hypoglycaemia in a study of 3805 children and adolescents with type 1 diabetes from the Hvidore Study Group. Diabetes Care 2001; 24: 1342-1347.
- 6. The Diabetes Control and Complications Trial Research Group. Effects of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. J Pediatr 1994; 125: 177-188.
- 7. White NH, Cleary PA, Dahms W, et al. Beneficial effects of intensive therapy of diabetes during adolescence: outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT). Diabetes Control and Complications Trial DCCT/Epidemiology of Diabetes Interventions and Complications. J Pediatr 2001; 139: 804-812.
- 8. Hoey H, Aanstoot HJ, Chiarelli F, et al. Good metabolic control is associated with better quality of life in 2101 adolescents with type 1 diabetes. Diabetes Care 2001; 24: 1923-1928.
- 9. Jones TW, Porter P, Sherwin RS, et al. Decreased epinephrine reponses to hypoglycaemia during sleep. N Engl J Med 1998; 338: 1057-1062.
- 10. Couper JJ, Taylor JD, Fotheringham M, Sawyer M. Failure of home based intervention to maintain benefits in adolescents with poorly controlled type 1 diabetes. Diabetes Care 1999: 1933-1937.