PEDIATRICS Vol. 74 No. 6 December 1984, pp. 1079-1085
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Research and Practice in the Treatment of Insulin-Dependent Diabetes: A Survey of 53 Pediatric Diabetologists

Robert Kaye MD1

1 From the Department of Pediatrics, Hahnemann University School of Medicine, Philadelphia

New techniques are available for the treatment of children with insulin-dependent diabetes mellitus. These include more intensive methods of insulin delivery by multiple daily injections or continuous subcutaneous infusion by portable pumps combined with patient self-monitoring of blood glucose. Long-term diabetic control can be evaluated by measurement of glycosylated hemoglobin, HbA1 or HbA1c. Pediatric practitioners may be in doubt as to the extent to which these techniques should be incorporated into their own practices. In order to provide some guidance in this quandry, the treatment practices as of June 1982, of 53 physicians with a special interest in the treatment of diabetic children were surveyed by questionnaire. The respondents estimated that they cared for 12,350 diabetic patients less than 19 years of age. Among their patients, 72% received twice-daily injections of insulin, 3% received three or more injections daily, and only 195 patients (2.7% of the total) were treated with insulin pumps. Among patients older than 10 years of age, 50% performed self-monitoring of blood glucose four times daily on one or more days per week and 32% of these patients did so daily. Two thirds of the patients utilized glucose oxidase-impregnated strips for blood glucose estimation and the remainder used reflectance meters. Essentially all respondents utilized glycosylated hemoglobin to evaluate quality of control. The mean number of determinations was 3.8 per year. Reasons for introducing pump therapy or discontinuing its use, glycemic targets for pump patients, and experience with utilization of the pump are described. Recommendations for the management of juvenile diabetes include: periodic determinations of glycosylated hemoglobin to evaluate quality of control; initiation, in children beyond the toddler age, of self-monitoring of blood glucose to guide insulin dosage for the purpose of achieving near-normal levels of blood glucose; and treatment of most patients with two daily injections of a combination of rapid and intermediate-acting insulins. For patients not responding to the above measures, initiation of pump therapy is an option provided that the patient is highly motivated and emotionally sound, and an experienced treatment team is available for supervision.

Key Words: juvenile diabetes • insulin-dependent diabetes • intensive treatment of diabetes • insulin pump therapy • current therapy in diabetes

Submitted on October 11, 1983
Accepted on February 16, 1984