MECHANISMS INVOLVED IN THE METABOLIC CONT ROL OF DIABETIC CHILDREN AND ADOLESCENTS

Aim of the study: To evaluate the role of diabetes duration, age, pube rtal stage, compliance and economical-cultural factors on the metaboli c control in insulin-dependent diabetic subjects. Subjects and methods : 497 diabetic patients (267M/230F) have been evaluated, mean age 16.2 +/-4 years, mean duration of diabetes 9.0+/-4.1 years, mean HbA1c 9.0/-1.9%. HbA1c was evaluated by high performance liquid chromatography, normal values 4-6%. Diabetes duration was divided in 6 groups: 6, 6.1 -8, 8.1-10, 10.1-12, 12.1-14 e > 14 years. Age was divided in four gro ups: < 12, 12.1-15, 15.1-18 e > 18 years. Pubertal stage was assessed according to Tanner sexual maturity ranking (P1-P5). patients with pub ertal stage P3-P4 were assigned to three groups based on the 1st and 3 rd quartiles or their glycated haemoglobin values. Compliance, scholas tic performance, economical and cultural levels of the parents have be en assessed too. Results: HbA1c doesnt significantly correlate with di abetes duration, but correlate significantly, with age (p < 0.01) and pubertal stage (p < 0.01). Worst degree of metabolic control has been observed in subjects with age between 12 and 18 years (mean HbA1c 9.4% ) and pubertal stage P3-P4 (mean HbA1c 9.5%). Patients with pubertal s tage P-3-P-4 and HbA1c < 1 degrees quartile (mean HbA1c 7.1+/-1%), bet ween 1 degrees-3 degrees quartile (mean HbA1c 9.3+/-0.5%) and > 3 degr ees quartile (mean HbA1c 11.8+/-1.2%) were comparable for compliance, economical-cultural levels of the parents and clinical parameters. Sub jects with worst metabolic control were characterized by worse scholas tic performance (p < 0.05). Conclusions: age between 12 and 18 years a nd pubertal stage P3-P4 are correlated to the worst degree of metaboli c control. Duration of diabetes doesn't seem to influence metabolic co ntrol. Between the investigated parameters, only scholastic performanc e was significantly worst in patients with insufficient metabolic cont rol.