The continuing challenge of outcome disparities in children with diabetes.

Abstract

Type 1 diabetes (T1D) is associated with the development of debilitating, life-shortening complications related to chronic hyperglycemia. In 1993, the landmark Diabetes Control and Complications Trial (DCCT) demonstrated that carefully supervised, intensive basal-bolus insulin therapy that led to the chronic reduction of HbA1c to normal or near-normal levels could prevent the occurrence and progression of microvascular complications.1 The DCCT findings led to the use of HbA1c as the main clinical indicator of treatment effectiveness, recommendations for patient HbA1c treatment goals in the normal/near normal range, and advocacy of intensive insulin management to achieve those goals.2,3 In the 2 decades since the DCCT, there have been many technical advances in insulin formulations, insulin delivery systems, and blood glucose monitoring to facilitate the achievement of HbA1c outcome goals. Despite these changes, the T1D Exchange Clinic Network found that the majority of pediatric patients in their survey still did not reach recommended HbA1c goals4 and thus remain at potentially higher risk … Address correspondence to Stuart A. Chalew, MD, 200 Henry Clay Ave, Children’s Hospital of New Orleans, New Orleans, LA 70118. E-mail: schale{at}lsuhsc.edu