Metabolic Control in Children with Type 1 Diabetes

Abstract

Since 1993, diabetes therapy has been intensified in several ways: insulin analogues have been introduced and insulin pump therapy has been established as a standard therapy in paediatric diabetology, improved devices for self-control have been developed and continuous glucose measurement has been introduced in diabetes monitoring. These technical improvements have been accompanied by new training programmes for children and adolescents with diabetes and their relatives. These programmes aim to empower the patient and his or her family to self-manage diabetes and not to depend on professional advice, as was previously the case. Interdisciplinary teams have been established to train and support families in the management of diabetes. There was a big hope that these improvements would result in a significantly better metabolic situation. This article reviews the changes in diabetes treatment and the outcomes over the last few years: the average glycated haemoglobin (HbA 1c ) levels fell only marginally, although insulin therapy was intensified considerably; the insulin dose increased and resulted in weight gain. However, the proportion of patients with good metabolic control increased and the proportion of patients with bad metabolic control dropped. Intensifying therapy also resulted in fewer hypoglycaemic episodes, particularly if insulin pumps were used. As well as technical improvements, it is important to address the patient’s situation, problems and needs, and it is necessary to individually tailor diabetes therapy. The new devices and training programmes will help us to reach this goal and eventually reduce the rate of diabetic complications.