904 HEMOGLOBIN A1C AND “TIGHT” BLOOD GLUCOSE CONTROL IN NEWLY DIAGNOSED JUVENILE DIABETICS

Abstract

The recent demonstration that glycosylated hemoglobin measurements correlate with integrated blood glucose levels over the preceding 1 to 2 months and the mounting experimental evidence that maintenance of normal blood glucose levels may reduce diabetic complications, suggests that early vigorous treatment of newly diagnosed juvenile diabetics, monitored by Hb A1C measurements, may be important in the long-range managements of these children. Fifteen youngsters, ages 3 to 18, were studied at the time of diagnosis of insulin-dependent diabetes and sequentially at 1 to 2 months intervals. Initial concentrations of Hb A1C were 8.6±1.2% of total hemoglobin (normal, non-diabetic children 2.2-4.8%), indicating the presence of hyperglycemia for a significant period of time prior to diagnosis. Within 4 to 6 weeks after diagnosis and placement of the children on a therapeutic regimen designed to promote normoglycemia, Hb A1C values declined to 5.4±0.9% and were maintained at these levels in 12 of the 15 patients for periods ranging up to one year. No significant hypoglycemic reactions occurred in any of the children on the “tight control” protocol which included high protein meals plus 3 snacks per day, daily afternoon exercise and a combination of intermediate and short acting insulin given once or twice per day. The results indicate that it is possible to maintain insulin dependent diabetic children in a relatively euglycemic state that can be monitored sequentially by Hb A1C determinations.