HOW TO APPLY THE EXPERIENCE FROM THE DIABETES CONTROL AND COMPLICATIONS TRIAL TO CHILDREN AND ADOLESCENTS

The Diabetes Control and Complications Trial (DCCT) taught us to set t arget blood glucose (BG) and glycohaemoglobin (GHb) goals, to ensure s afety regarding hypoglycaemia, to be flexible with insulin and meal pl anning and to offer frequent contact with diabetes educators, dieticia ns, psychologists and social workers as well as with diabetologists sk illed in intensified management. Insulin dosage should be individualiz ed based upon frequent BG monitoring results. Go-ordinated multidiscip linary health care teams provide optimum problem-solving rather than d isaster control working with children, adolescents and their families. The patient and the family should form the central core of the diabet es team with outpatient follow-up every month and frequent telephone c ontact between visits. GHb should be obtained at least every 1-2 month s to provide feedback as based on the DCCT intensified treatment cohor t. Insulin lispro helps minimize hypoglycaemia and makes insulin admin istration more convenient and timely Barriers to improvement should be identified: learning problems, concomitant significant illnesses (epi lepsy, coeliac and thyroid disease, asthma) and family problems. Ensur e age-appropriate transfer of self-care but continue adult supervision . Educate, motivate and re-educate. Meal planning includes not only ca rbohydrate counting but also maintaining normal lipids and energy need s for growth and development as well as strategies for activity compen sation and hypoglycaemia prevention. Consideration of protein restrict ion may be required in adolescents with microalbuminuria. Individualiz ed multidose insulin algorithms allow reactive (corrective) decisions based upon capillary BG results plus proactive (anticipatory) decision s to compensate for expected BG changes from changes in activity, food and/or illness using a multidose insulin schedule. The number of insu lin injections does not define an intensified insulin treatment progra mme but rather the ability to target and achieve near-normal BG values as often as possible - without severe episodes of hypoglycaemia. Self BG monitoring is a key to success. Long-term monitoring should includ e not only frequent GHb but also at least annual fasting lipids, thyro id functions and microalbuminuria as well as dilated retinal exams, bl ood pressure, growth charting and Tanner staging.