GLYCATED HEMOGLOBIN AND RELATED FACTORS IN DIABETIC CHILDREN AND ADOLESCENTS UNDER 18 YEARS OF AGE - A BELGIAN EXPERIENCE

OBJECTIVE - To determine, in an unselected population of diabetic chil dren and adolescents < 18 years of age, which HBA(1c) levels can be ac hieved, and to examine the relationships with insulin regimen, insulin dose, sex, diabetes duration, BMI, and frequency of home blood glucos e monitoring (HBGM) and outpatient clinic attendance. RESEARCH DESIGN AND METHODS - A total of 144 unselected subjects (73 boys and 71 girls ) aged 11.8 +/- 3.7 years (mean +/- SD) were included in the study ove r a 6-month period. They had diabetes durations ranging from 5 months to 15 years (4.0 +/- 3.0). They were followed by the same pediatric di abetologist and same nurse. The yearly frequency of visits was 8.9 +/- 2.0, and the monthly frequency of HBGM was 111 +/- 27. Of the patient s, 129 were treated with two daily insulin injections of an individual ized mixture of rapid- and intermediate-acting insulins, and 15 adoles cents were treated with four injections using the basal-bolus regimen. The patients were divided into two subgroups according to diabetes du ration: less than or equal to 2 years (n = 53) and >2 years (n = 91), i.e., outside the honeymoon period. HBA(1c) was measured by a high-pre ssure liquid chromatography method (normal values 3.9-5.5%). RESULTS - The mean +/- SD HbA(1c) level in the 144 children and adolescents was 6.6 +/- 1.2% using our method. In 62% of the patients, it was possibl e to obtain an HbA(1c) level under the normal mean value plus 5 SD. Hb A(1c) was not related to sex, number of insulin injections, or age, i. e., it was not poorer at adolescence. The mean daily insulin dose was 0.9 U/kg body wt, being lower during the first 2 years of diabetes and reaching 1 U at adolescence. HbA(1c) was negatively correlated with t he frequency of HBGM. The yearly incidence rate of severe hypoglycemic episodes was 0.2. After the age of 13 years, BMI was significantly hi gher in girls and in adolescents on four daily injections. CONCLUSIONS - In nearly two-thirds of diabetic children and adolescents, it is po ssible to obtain HbA(1c) levels under the normal mean plus 5 SD, which is considered satisfactory and close to that of the adult cohort of t he Diabetes Control and Complications Trial (DCCT) with intensive trea tment. There is no difference between the children on only two daily i nsulin injections and the adolescents on four injections. After 2 year s of diabetes, increased frequency of HBGM helps reduce HbA(1c) levels , taking into account the ''intensive'' education of the patients and their families. Adolescent girls on four injections must pay attention to the risk of becoming overweight.