Metabolic control in Bernese children and adolescents with diabetes mellitus type I

Aims/hypothesis: Tn diabetes mellitus type I, good glycaemic control is cru cial in preventing long-term diabetic complications. The aim of this study was to determine the current level of metabolic control in children and ado lescents in our diabetes outpatient clinic at the University Children's Hos pital, Berne. Furthermore, the impact of different factors such as age, pub ertal stage, sex, duration of diabetes and insulin regimen on glycaemic con trol was studied. Methods: In a cross-sectional, prospective study 168 children and adolescen ts with type I diabetes mellitus (f:m = 87:81; prepubertal 48 [mean age 4.4 years, mean duration of diabetes 2.8 years]; pubertal 120 [mean age 9.4 ye ars; mean duration of diabetes 5.2 years]) were studied for three months. C linical data and HbA(1c) levels (latex immunoagglutination test) were recor ded, statistically analysed and compared with the international literature. Results: In our type I diabetic children and adolescents the overall HbA(1c ) was 8.07 +/- 1.15% (mean +/- SD; test-specific norm for healthy subjects: 4.1-6.1%). Glycaemic control was significantly worse in the pubertal group compared to the prepubertal (HbA(1c) 8.22 +/- 1.25% vs. 7.81 +/- 0.87%; p < 0.01). In addition,we found better metabolic control in patients with dur ation of diabetes below 2 years in children and adolescents (HbA(1c) prepub ertal <2 years: 7.45 +/- 0.67% vs. >2 years: 8.05 +/- 0.93%, p < 0.05; pube rtal <2 years: 7.62 +/- 0.75% vs. >2 years: 8.31 +/- 1.29%, p < 0.005). Imp ortantly sex and insulin regimen did not significantly influence glycaemic control. Conclusion/interpretation: The current level of metabolic control in our ch ildren and adolescents with diabetes mellitus type I is comparable to the g lycaemic control of the intensively treated adolescent group of the DCCT-st udy, in whom decreased risk of long-term diabetic complications was found. In contrast, our patients were intensively treated in terms of frequent con tacts with the diabetes team, bur were not necessarily on an intensified in sulin regimen. The impact of biopsychosocial support from multidisciplinary diabetes team on good metabolic control in children and adolescents with t ype I diabetes mellitus and their families seems to be very important.