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 receivin6g 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.