Practical aspects of managing diabetes in adolescents

In 1988 and 1990 screening for HbA(1c) and albumin excretion rate in diabetic children was carried out throughout Denmark. Each study included approximately 1000 diabetic patients. Raised levels of HbA(1c) (9.5-10%) were found despite 60% of these young people receiving three or more insulin injections daily. The prevalence of persistent microalbuminuria was 4.3%, which was associated only with age and diastolic blood pressure. A recent international survey of HbA(1c) and insulin treatment involving 2873 children found an average HbA(1c) of 8.6% +/- 1.7%, which varied significantly (p < 0. 0001) between centres. Severe hypoglycaemia was related to a young age (0-8 y) and low HbA(1c). There were no significant differences in glycaemic control between adolescents treated with two, three, four or more insulin injections daily. Adolescents on four or more injections received significantly (p < 0.001) more insulin. Girls receiving four or more injections had a significantly (p < 0.01) higher body mass index than girls on twice-daily insulin. Preadolescent children on premixed insulin showed similar HbA(1c) levels to those on a combination of short- and long-acting insulin, whereas in adolescents, significantly better HbA(1c) values were achieved with individual combinations. Despite intensive diabetes management, particularly in adolescence, near normoglycaemia is achieved only in a few individuals.