METABOLIC CONTROL IN CHILDREN WITH INSULIN-DEPENDENT DIABETES-MELLITUS 5-Y AFTER DIAGNOSIS - EARLY DETECTION OF PATIENTS AT RISK FOR POOR METABOLIC CONTROL

Children (n = 38) aged 3-15 y were randomly chosen, at the time of dia betes diagnosis, for conventional management at a hospital ward, or fo r treatment partly in a training apartment where the family was offere d problem-based education and special therapeutic support. HbAlc, bloo d glucose stability, urinary C-peptide excretions and incidence of hyp oglycaemic attacks and diabetes ketoacidosis (DKA) were monitored and some standardized, self-estimated psychological tests were performed d uring the first 2 y after diagnosis. During the 3 y thereafter, HbAlc, presence of DKA, microalbuminuria, retinopathy and hypertension were monitored. None of the patients demonstrated signs of diabetes microan giopathy or DKA. The overall mean HbAlc level was 7.2% 5 y after diagn osis and 30% of the children had HbAlc values <6.3%. There were no dif ferences in the HbAlc values for the patients treated by the different management regimens. Blood glucose variability (SD) was also similar, with 75% of the values in the range of 3-10 mmol/l. Patients with poo r glycaemic control (mean HbAlc >8.3%) year 5 after diagnosis had alre ady the second year after diagnosis significantly higher HbAlc values and blood glucose variability. The fathers of these patients demonstra ted a higher degree of maladjustment. On the basis of increasing HbAlc values, high blood glucose variability and psychosocial risk factors such as their fathers' emotional responses, patients at risk for poor metabolic control in the future can be identified within 2 y after dia gnosis. Efforts and resources can thus be focused at an early stage on this group.