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Children's Health

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Children with insulin-dependent diabetes are hospitalized three times more often than other children

Specialists caring for children with insulin-dependent (type 1) diabetes struggle to lower excessively high blood-sugar levels (glycemic control) that can lead to diabetes-related eye, kidney, and other complications, while minimizing the risk of acute problems such as severe hypoglycemia (low blood sugar levels that can lead to convulsions or coma), which often result in hospitalizations and emergency department (ED) visits. Despite improvements in diabetes care, these young people are hospitalized more than three times as often as the general pediatric population. The only factor that reduced these hospitalizations was frequent self-monitoring of blood glucose levels, according to a study supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00063).

Doctors should stress good diabetes management, especially blood glucose monitoring (BGM), which tends to become more lax during the adolescent years. BGM provides information on which to base adjustments in insulin dosages, meal plans, and exercise regimens to ultimately improve glycemic control, explain the researchers from Children's Hospital in Boston and Harvard Medical School. They used questionnaires and medical records to assess how glycemic control affected the incidence of adverse events, hospitalizations, and ED visits of 300 youngsters (7 to 16 years of age) with type 1 diabetes, who were receiving care at a diabetes specialty clinic over a 1-year period. They were prescribed daily insulin injections, diet and exercise education, instruction in BGM, and advice on sick-day management.

Despite multidisciplinary care, glycemic control (measured by glycosylated hemoglobin or HbA1c levels) did not improve over the 1-year study period, from a mean HbA1c of 8.7 percent at baseline to 8.9 percent a year later; good glycemic control is considered 7 percent or less. Poorer control was associated with older age, advanced puberty, and longer duration of diabetes. Patients who performed BGM five or more times per day had HbA1c levels of 8 percent compared with 9.1 percent for those performing BGM once per day or less. Overall, the rate of hospitalization was 13 per 100 person-years, but it was significantly higher (25 per 100 person-years) in the highest HbA1c tertile (HbA1c greater than 9 percent).

See "Predictors of glycemic control and short-term adverse outcomes in youth with type 1 diabetes," by Bat-Sheva Levine, M.D., Barbara J. Anderson, Ph.D., Deborah A. Butler, M.S.W., and others, in the August 2001 Journal of Pediatrics 139, pp. 197-203.

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