Metabolic Compensation of Diabetic Children: Study Edmonton - Prague 1993 - 1999

Overview

The authors compared in 1993 treatment and metabolic control (expressed as the HbA1c level) in diabeticchildren and adolescents under the age of 18 years in the Czech Republic (Prague) and in Canada (Edmonton).The supplementary analysis was implemented in 1999 in Prague. In 1993 participated 176 patients from Prague(age 13.1 ± 4.0 years; duration of diabetes 6.0 ± 3.6 years) and 158 children from Edmonton (age 11.6 ± 3.5 years;duration of diabetes 4.7 ± 3.0 years), in 1999 63 patients from Prague (age 12.5 ± 3.7 years; duration of diabetes4.7 ± 3.0 years). In Prague the patients were treated by multiple daily insulin injections (MDI), in Edmonton byconventional insulin treatment (CIT). Knowledge of the principles of diabetes treatment were assessed by meansof a standard questionnaire. In 1993 Edmonton children were better compensated (HbA1c 9.3 ± 1.8%) than Praguechildren (HbA1c 9.9 ± 1.7%, p < 0.001) despite the smaller number of insulin doses per day. Edmonton childrenassessed their blood sugar level more frequently at home (21.1 ± 7.2 examinations per w eek) than Prague children(10.2 ± 6.4, p < 0.001) and their parents had better knowledge of diabetes (p < 0.001). The subsequent analysis in1999 in the intensively monitored group of diabetic children in Prague had the best metabolic control (HbA1c 7.3± 1.0%, p < 0.001) incl. significantly more frequent monitoring of the blood sugar level at home (number ofassessments per week 25.9 ± 5.2, p < 0.001). The most significant predictor of compensation was in all groupsduration of diabetes (1993: r = 0.30, p < 0.001; 1999: r = 0.41, p < 0.01), followed by the frequency of blood sugarmonitoring. For compensation the knowledge of adolescent patients than that of their parents was more significant.The results indicate that a mere increase in the number of insulin injections per day d oes not improve the metaboliccontrol of diabetic children unless associated with frequent monitoring of the blood sugar level at home and healtheducation. The encouraging results in 1999 provided evidence that under Czech conditions it is possible to achievebetter compensation of diabetes in children than reported by some of renown world centr es.

Key words:
type 1 diabetes, metabolic control, children, insulin injection regimen, blood glucose monitoring,