Group Of Diabetic Children Research Articles

Prevalence of Periodontal Disease in a Group of Egyptian Children with Diabetes Mellitus Type 1

Abstract Background: Diabetes Mellitus (DM) is a serious meta-bolic syndrome with its two basic types resulting in abnormal fat, carbohydrate, and protein metabolism. Periodontal disease is considered as the sixth leading complication for individuals suffering from diabetes mellitus. Periodontal disease can be initiated, developed and progressed because of metabolic imbalances in the tissues which lower the diabetic patients resistance of diabetics to infection. Aim of Study: The aim of this study was tostudy periodontal disease experience in a group of diabetic children and the unmet treatment needs. 3 to 12 years old suffering from type 1 diabetes mellitus. Material and Methods: 91children with type 1 diabetes mellites, their ages range from 3 to 12 participated in the study with the mean time since the onset of diabetes was 5.41±3.13 years in boys and 4.88±2.29 years in girls. Results: There was a significant differencecorrelation between HbA1c and periodontitis and diabetic ketoacidosis attacks. Conclusion: Elevated blood glucose levels in patients with diabetes mellitus patients is prominently associated with periodontal disease in the form of periodontitis and xerostomia leading to high risk of ketoacidosis attacks.

Effect of Antioxidant Supplementation on Total Antioxidant Status in Indian Children with Type 1 Diabetes

ABSTRACTHyperglycemia results in the overproduction of free oxygen radicals that impair the endogenous antioxidant defenses. A randomized controlled trial was conducted to compare the effect of 3 months of antioxidant supplementation in the form of foods rich in micronutrients with pharmacological supplement on total antioxidant status of Indian children with type 1 diabetes. Ninety children with diabetes (mean age 11.5 ± 3.6 yrs, 37 boys) were randomly allocated to three groups: Group 1 (n = 31) = DM controls; Group 2 (n = 30) = multimicronutrient syrup; and Group 3 (n = 29) = dietary supplements (nine snack recipes rich in micronutrients). They received intervention for 3 months. Healthy controls were enrolled from local schools. Fasting blood was tested for total antioxidant status (TAS) and glycosylated hemoglobin (HbA1C). Children with diabetes had lower TAS (0.70 ± 0.2 vs. 1 ± 0.24 mmol/l, p = .0001) compared to healthy controls. Anthropometric and biochemical parameters were similar at baseline for all groups of diabetic children. Group 1 showed significant deterioration in TAS at endline (0.72 ± 0.16 vs. 0.60 ± 0.17 mmol/l, p = .008). Increase in TAS recorded in Group 2 was from 0.66 ± 0.21 to 0.70 ± 0.16 mmol/l and in Group 3 was from 0.68 to 0.73 mmol/l. There was a significant difference between Group 1 and Group 3 for percentage change in TAS (−13% vs. 16%, p = .035). Postsupplementation there was an increase in TAS values in children with diabetes, but they were still lower than in healthy controls. Indian diabetic children have compromised antioxidant status, which may be improved by incorporation of multimicronutrient-rich recipes in their diets.

Physical Growth and Body Composition of Controlled Versus Uncontrolled Type 1 Egyptian Diabetic Children

BACKGROUND: Type 1 Diabetes Mellitus (T1DM) is one of the most common chronic endocrine disorders of childhood. Data on growth parameters of diabetic children is scarce. AIM: To assess growth and body composition in a group of diabetic children. SUBJECTS AND METHODS: 427 T1DM children (age 2-10 years) were recruited from Diabetic Paediatric Unit, outpatients' clinic of Abou El-Rish Hospital. Anthropometric and body composition parameters were taken and HbA1c was measured for all subjects. RESULTS: Highly significant difference was detected between controlled and uncontrolled groups as regard to weight/age z-score, height/age z-score, BMI z-score, triceps skin fold thickness, subscapular skin fold thickness, midupper arm circumference, fat mass, fat %, lean mass, and body water (p < 0.001). All values are higher in the controlled group than in the uncontrolled group. Uncontrolled subjects were significantly more at risk of being underweight and short, with odds ratio of 15.131 and 16.877 and 95% confidence interval 1.972-116.130 and 3.973-71.694 respectively. However, controlled subjects were significantly more at risk of being obese than the uncontrolled with an odds ratio 0.116 and 95% confidence interval 0.045-0.302. CONCLUSION: Growth was compromised in uncontrolled T1DM children. This is of utmost importance since most of the clinical features are reversible with better glycemic control and appropriate insulin management.

Prevalencia de obesidad y de factores de riesgo cardiovascular en una población de pacientes pediátricos con diabetes tipo 1

ObjectiveTo establish the prevalence of overweight-obesity and metabolic syndrome in a group of paediatric patients with type 1 diabetes (DM1), and to determine the effects on the lipoprotein profile and metabolic control. MethodsA group of 115 patients (5-16 years) with DM1, and on intensive insulin therapy was studied. Weight, height, body mass index (BMI), waist circumference (WC), blood pressure (BP), glycosylated haemoglobin (HbA1c), total cholesterol (TC), HDL-cholesterol (HDL-c), LDL-cholesterol (LDL-c) and triglycerides (TG) were measured. The results were stratified by sex and age (< 11 years and ≥ 11 years). ResultsThe prevalence of overweight and obesity (according to Hernández's reference values) was 28.69% and 18.26%, respectively, with female predominance in both cases. The prevalence of metabolic syndrome (according to the International Diabetes Federation criteria) was 3.22%. 3.47% The WC adjusted for age and sex was > 90th percentile in 3.47% of cases, and 2.6% had a systolic BP ≥ 130mmHg and/or a diastolic BP ≥ 85mmHg. An HDL-c < 40mg/dl was seen in 4.34%, and 2.6% had TG ≥ 150mg/dl. Obese patients had lower HDL-c levels and higher LDL-c levels than non-obese subjects. There were no significant differences in HbA1c between patients with overweight-obesity and the rest. ConclusionsOverweight and obesity are common in paediatric patients with DM1. Nevertheless, the prevalence of metabolic syndrome and cardiovascular risk factors is lower than in adult patients. The group of diabetic children with obesity had a lipoprotein profile of cardiovascular risk.

Erythrocyte lipid composition at different stages of type 1 diabetes in children

Complete profiles of phospholipid and ceramide molecular species from erythrocyte lipid extracts of children without carbohydrate metabolism disorders, and children with type 1 diabetes were compared by means of high performance liquid chromatography/mass spectrometry. For the first time a statistically significant increase (p<0.05) of lysophosphatidylcholine content in two groups of diabetic children with different duration of the disease (less than one year and more than one year) was found. Statistically significant changes in other lipid classes were not observed. The dependence of the content of phosphatidylcholine and phosphatidylethanolamine molecular species containing arachidonic acid residue (20:4) on the duration of the disease was found. The observed shift in lipid metabolism suggests of phospholipase A2 and chronic inflammatory process at different stages of diabetes mellitus, in cells (erythrocytes), which aer not involved in the immune response.

Diferencias de estado nutricional, control metabólico y tratamiento de la diabetes tipo 1 en dos décadas

Objective The aim of this study is to describe changes in anthropometric characteristics, metabolic control, treatment and prevalence of overweight in diabetic children (DM1) from 2007 compared with another similar group from 1986. Patients and methods Observational retrospective study of two groups of diabetic children (n = 90). The collection of variables has been made at two cross-sections, 1986 and 2007. The studied variables were: age, years of DM1, sex, weight, height, BMI (and their Z values), HbA 1c and treatment with insulin (type, number of doses, IU/day and IU/kg/day). Results In 2007 group there is a significant increase in Z-weight and Z-BMI ( P = .001) when compared with the 1986 group. There was a negative relationship between the years with DM1 and Z-height ( P = .05) in the 1986 group. The value of HbA 1c was lower in the 2007 group ( P = .001), but the dose of insulin (IU/day and IU/kg/day) was similar in both groups. The number of daily doses of insulin was higher in the 2007 group ( P < .001), the use of insulin analogues dominated overall. A statistically significant relationship between HbA 1c and treatment with insulin (dose injections, insulin type) was not found. The prevalence of overweight (14.6% vs 2.4%) was significantly higher in the 2007 Group ( P = .001). Conclusions The metabolic control (HbA 1c) had improved and the use of multiple daily doses of insulin has been become the standard, but the prevalence of overweight has increased. We must monitor the emergence of insulin resistance and cardiovascular risk factors in this sensitive population to prevent early cardiovascular disease.

Development and linear growth in diabetic children receiving insulin pigment

The aim of this study was to ascertain if there are differences in the development and linear growth between a group of diabetic children who had been receiving insulin pigment and healthy children. A total of 57 Chinese children with type 1 diabetes diagnosed at the age from 6 to 10 years old (26 boys and 31 girls) were included in the study. Their height and weight and development conditions were recorded until they reached their 18th birthday. Diabetic children were taller than healthy children at the onset of diabetes, even though there was no significant difference between them [male height standard deviation score (SDS): 0.34 +/- 0.93, female height SDS: 0.38 +/- 0.50]. When they reached their final height, they were slightly shorter than the healthy group. However, there were still no significant differences between these two groups (male height SDS: -0.42 +/- 0.95, female height SDS: -0.60 +/- 0.98). The median age at onset of puberty, 12.62 years in boys and 11.13 years in girls, was significantly delayed in diabetic boys compared to 10.55 years in healthy boys and 9.2 years in healthy girls. The median age at menarche in diabetic girls (14.15 years) was also delayed compared with 12.27 years in healthy girls. The majority of these diabetic children were thinner than the healthy children when they were diagnosed [male body mass index (BMI): 14.45 +/- 1.35 kg/m2 vs. 16.08 +/- 0.59 kg/m2, t = -0.63, p < 0.05; female BMI: 13.50 +/- 1.87 kg/m2 vs. 15.46 +/- 0.45 kg/m2, t = -6.67, p < 0.05]; however, as they reached their final height, they became fatter, especially the girls (male BMI: 21.43 +/- 1.62 kg/m2 vs. 20.8 +/- 0.00 kg/m2, t = 1.97, p > 0.05; female BMI: 23.95 +/- 2.37 kg/m2 vs. 20.3 +/- 0.00 kg/m2, t = 8.60, p < 0.05). Even with well-controlled glucose levels, the development of children with diabetes who had been receiving insulin pigment were still adversely affected. However, linear growth had only been slightly affected. All patients, especially girls, became fatter when they reached their final height.

Long-chain polyunsaturated fatty acids in a diabetic teenager during and after nine repeated episodes of diabetic ketoacidosis

Type 1 diabetes is often accompanied with acute hypoinsulinemia that may theoretically inhibit the conversion of essential fatty acids to their longer-chain metabolites. Previously, we found significant reduction in plasma arachidonic (C20:4n-6) and docosahexaenoic (C22:6n-3) acid values in a group of diabetic children during diabetic ketoacidosis. Here we report data on the changes of fatty acids in plasma phospholipids in a diabetic teenager during and after nine subsequent episodes of diabetic ketoacidosis (DKA). Plasma phospholipid linoleic acid (C18:2n-6) values significantly decreased [23.05 (1.05) versus 19.22 (3.22), % w/w, median (IQR), p < 0.01], while values of dihomo-gamma-linolenic acid (C20:3n-6) and docosatetraenoic acid (C22:4n-6) significantly increased [1.72 (0.44) versus 1.80 (0.63) and 0.40 (0.01) versus 0.45 (0.07), respectively, p < 0.05]. Values of alpha-linolenic acid (C18:3n-3) did not change, while values of docosahexaenoic acid were significantly higher after than during the ketoacidosis [1.57 (0.67) versus 1.87 (0.32), p < 0.05). These data obtained in the same patient during repeated episodes of diabetic ketoacidosis support the concept that hypoinsulinemia plays an important role in disturbances of essential fatty acid metabolism in diabetes.

Growth, puberty, and final height in children with Type 1 diabetes

Objective The aims of this study were to assess the physical growth and pubertal development in a group of diabetic children and to evaluate the effect of height at diagnosis, duration of illness, and degree of glycemic control on final height and sexual maturation. Research design A cohort of 72 Sudanese diabetic children, 7–13 years of age at diagnosis, was followed longitudinally from the onset of diabetes until the attainment of final height. Results The mean height standard deviation scores (SDS) at diagnosis were 0.04 in boys and −0.15 in girls, which was greater than their genetic target height (GTH). The growth velocity between diagnosis and final height was slow, with significant reduction in pubertal growth spurt. The mean final height attained by these children was lower than their GTH, a finding that contradicts most of the recently published reports. The average age at menarche in girls (15.1 years) and the mean age of full sexual maturation in boys (17.2 years) were significantly delayed in this group of diabetic patients. This retardation in physical growth and pubertal development was positively correlated with the duration of diabetes before the onset of puberty and glycated haemoglobin (HbA1c) concentration. The majority of these patients were thin at diagnosis of diabetes, with median body mass index (BMI) <22, but showed a remarkable, progressive weight gain during puberty, which was more evident in girls. The weight gain was independent of weight at diagnosis and duration of diabetes, but was positively correlated with the daily dose of insulin and HbA1c concentration. Conclusion Conventional therapy of diabetic children is associated with impairment of physical growth and delayed sexual maturation.

Impact of glycemic control on serum lipoprotein (a) in Arab children with type 1 diabetes.

Lipoprotein (a) (Lp (a)) is an independent risk factor for coronary artery disease (CAD), a major cause of death in patients with type 1 diabetes mellitus. Both type 1 diabetes and CAD represent major problems in Kuwait. Data on the effect of metabolic control on Lp (a) in diabetic children are limited and this is particularly true for Arab children. The objectives of the present study were to analyze serum Lp (a) levels in patients with type 1 diabetes compared with non-diabetic children, taking into account the effect of glycemic control. Circulating lipids, including Lp (a), were measured in serum samples from 60 prepubertal non-diabetic children and 58 prepubertal children with type 1 diabetes. Comparisons of Lp (a) concentrations were made between the non-diabetic and diabetic children with good to fair control (glycosylated hemoglobin (GHb) <11%) and a group of diabetic children with poor control (GHb > or = 11%). The mean serum Lp (a) level in all diabetic children was 187.62+160.43 mg/L, compared with 162.88+156.06 mg/L in the control group. The group of children with poor glycemic control had higher median Lp (a) levels (147.50 mg/L) than either the group of diabetic children with good to fair control (95 mg/L; P<0.028) or the group of non-diabetic children (125 mg/L; P<0.04). Moreover, 38.3% of poorly controlled diabetic children had elevated Lp (a) levels > or = 250 mg/L, compared with 12.5% of diabetic children with good to fair control and 16.7% of non-diabetic children (P<0.025 and P<0.039, respectively). No association was found between Lp (a), diabetes duration and insulin dose. In Arab children, highest Lp (a) levels are associated with poorest metabolic control. The prevalence of Lp (a) levels associated with cardiovascular risk is higher in poorly controlled diabetic children. Increased levels of Lp (a) may be another contributing factor to the high risk for CAD in diabetic patients.

P19 Differences between groups of diabetic children with good and poor metabolic control

P19 Differences between groups of diabetic children with good and poor metabolic control

Reproducibility of erythrocyte sodium-lithium countertransport activity and ambulatory blood pressure measurements in type 1 diabetes mellitus.

We aimed to study the reproducibility of sodium-lithium countertransport [SLCT] activity and ambulatory blood pressure monitoring [ABPM] in type 1 diabetes. We did this by performing repeated measurements of SLCT activity and ABPM in 11 recent-onset diabetic children and in 11 patients with longer duration of diabetes. Both parameters were related to microalbuminuria. In the older group of diabetic children a significant correlation [r = 0.78; P<0.005] in SLCT activity between the first and second study was observed [514.3+/-186.4 vs 491.0+/-148.0 micromol/l erythrocytes/h]. Diurnal systolic and diastolic blood pressure were comparable at both time points within the same group of diabetic children [in group 1: 102.6+/-6.1 vs 108.6+/-7.6 mmHg N.S.; in group 2: 113.4+/-10.6 vs 114.0+/-7.8 mmHg N.S. Diastolic blood pressure in group 1: 57.4+/-4.8 vs 65.7+/-6.9 mmHg N.S., in group 2: 70.6+/-9.1 vs 68.5+/-5.3 mmHg N.S.]. Moreover, there was a significant correlation in both diurnal and nocturnal systolic blood pressure between the first and second study in the whole diabetic population. Both SLCT activity and blood pressure values obtained by ABPM were found to be reproducible individual characteristic markers in type 1 diabetic children.

241 SIZE OF PANCREAS IN CHILDREN AND ADOLESCENTS WITH TYPE 1 DIABETES MELLITUS: A STUDY BASED ON ULTRASONOGRAPHIC EVALUATION

The size of pancreas was evaluated by ultrasound in a group of 60 children (30 males) and adolescents with type 1 diabetes mellitus; the age ranged from 3 to 15 years and the duration of the disease from 1 to 13 years. Sixty sex- and age- matched healthy children were the controls (C). The children were divided into three groups: group A and AC, aged 3 to 7 years; group B and BC, aged 8 to 11 years; group C and CC, aged 12 to 15 years. We measured longitudinal and transverse diameters of the pancreatic head, body and tail and total area.The area of the pancreas was significantly smaller in diabetic children of all the groups when compared with C (area, A vs AC: 8.3 ± 2.6 cm vs 10.1 ± 2.5, p < 0.05. B vs BC: 9.3 ± 3.6 vs 12.7 ± 4.5, p < 0.05. C vs CC: 8.1 ± 3.1 vs 14.8 ± 2.6, p < 0.005). The sum of the diameters was lower in the 3 groups of diabetics (A vs AC: 117.7 ± 22.2 mm vs 136.7 ± 14.8, p < 0.005. B vs BC: 117.4 ± 17.1 vs 144.7 ± 24.5, p < 0.002. C vs CC: 112.2 ±32.6 vs 163.6 ± 15.0, p < 0.01). Diabetic subjects with duration of disease < 2 yr had pancres size similar to that of children with duration of diabetes > 2 yr. (area 9.0 ± 3.6 cm2 vs. 8.4 ± 3.5, p > 0.05: sum of diameters 123.1 ± 20.9 mm vs 113.2 ± 21.6, p > 0.05). No difference was found among the three groups of diabetic children. Significant reduction of the size of pancreas was evident already after I year of disease. In diabetics the size of pancreas was significantly (p < 0.005) related to basal C-peptidc levels. In C area and diameters of pancreas were positively related (p < 0.001) to age, weight, height, waist and thigh circumference and the tickness of abdominal wall. In diabetic children no correlation was found.In conclusion, the size of pancreas is significantly reduced in children with diabetes: furthermore, the disease interferes with the normal growth of the pancreas.

Diabetic Children and Their Parents: Personality Correlates of Metabolic Control

Test measures of field-dependence-independence and impulsiveness-control were obtained from two groups of diabetic children and their parents, the children being in optimal (O, n = 12) or poor (P. n = 27) metabolic control and, according to the judgment of clinicians, showing optimal or poor psychological adaptation. Children of the O-group scored lower in impulsiveness and higher in realistic functioning than those of the P-group. Differences which parallelled these were found between the two groups of fathers. The P-group fathers were decidedly more field-dependent than their wives, while the opposite was found for the O-group. Group differences of the kind obtained were seen as possible determinants of disturbed family interaction or emotional stress in the child in the P-group and of autonomy and self-reliance in the child in the O-group. It is concluded that the role of fathers of diabetic children has been underestimated.

Investigation of Subclinical Signs of Autonomic Neuropathy in the Early Stage of Childhood Diabetes

It has been suggested that subclinical signs of neuropathy appear earlier than microvascular complications of diabetes. To evaluate the occurrence of autonomic nervous system dysfunction in the early stage of childhood diabetes, subclinical signs of autonomic neuropathy (resting heart rate, hyperventilatory arrhythmia, standing/lying heart rate ratio, orthostatic decrease in blood pressure, and increase in blood pressure during sustained handgrip) were investigated in 54 children with type 1 diabetes divided into three groups: 14 recent-onset diabetics (3 weeks after the diagnosis), 20 diabetics in the remission phase, and 20 patients after the remission phase. 30 healthy age-matched children were used as control group. The mean resting heart rates of the diabetic groups in the remission phase and after the remission phase were significantly higher than those in the healthy control group (81.7 +/- 5/min and 88.5 +/- 6/min vs. 72.2 +/- 8/min; p less than 0.01). The hyperventilatory arrhythmia in the group of diabetic children after the remission phase in comparison with the control group was significantly decreased (29.1 +/- 4/min vs. 22.7 +/- 3/min; p less than 0.01). In a few cases of the recent-onset diabetic group, the increase in resting heart rate, the decrease in hyperventilatory arrhythmia, and the standing/lying heart rate ratio proved to be significant. In the remission phase, the same parameters showed abnormal values in one third to one fifth of the children.(ABSTRACT TRUNCATED AT 250 WORDS)

Long term feasibility of multiple daily injections with insulin pens in children and adolescents with diabetes.

During a period of 17 months, 15 C-peptide negative insulin-dependent diabetic children (14 +/- 4 years old) have used an injector pen (Novopen, Novo, France) to deliver soluble insulin before meals, in association with an insulin syringe for long-acting insulin administration at bedtime. Despite frequent daily insulin injections (4-5) and blood glucose determinations (3-4), long-term patient acceptability as well as cutaneous tolerance were excellent. Novopen was experienced as a progress (100%) which made a multiple injection regimen acceptable and provided an improvement in the quality of life (77%), as recorded by questionnaires answered at the end of the study. Twelve out of 15 patients chose to continue this treatment. No significant change in glycaemic control was observed in the group as a whole. An improvement in glycosylated haemoglobin (HbA 1c) was noticed only in the previously "poorly-controlled" children (n = 8) with initial HbA1c greater than 7%. In this group HbA1c decreased from 8.4 +/- 1.8% (mean +/- SD), to 7.3 +/- 1.2% (P less than 0.05) within the first 6 months of Novopen therapy. No increment of hypoglycaemia frequency and mean daily insulin requirements was observed. No ketoacidotic episode was noticed during the study. In conclusion, in this group of diabetic children, no long term metabolic improvement was obtained, despite excellent acceptability of the multiple injection regimen with Novopen.

Persisting glomerular hyperfiltration in short-term diabetic children without microalbuminuria.

The renal function in a group of diabetic children (n=29;age;4-17 yr; IDDM duration: 1,5-13 yr) was studied with a 3 year interval. At the first evaluation glomerular filtration rate (GFR) as assessed by inulin clearance was significantly increased compared to control values (167 +/- 32 vs. 124 +/- 18 ml/min/1.73 m2; pl less than 0.01). Eighteen out of 29 children exhibited a glomerular hyperfiltration (GFR greater than 160). Three years later mean GFR was identical (169 +/- 25 ml/min/1.73 m2) and 16 children were hyperfiltrating. Among them, 11 have had a persisting glomerular hyperfiltration over the 3-year period. Renal plasma flow (RPF) was positively correlated to GFR (r=0.7; p less than 0.01) and remained elevated at both evaluations (794 +/- 163 and 812 +/- 157 ml/min/1.73 m2, p greater than 0.01 vs, control values). When the children were separated into 3 groups according to IDDM duration no significant differences were observed in the results for GFR and RPF, Mean urinary albumin excretion was comparable at the 3-year interval, and not significantly different from the control values (5.2 +/- 3.7 and 8.2 +/- 6.6 respectively vs. 8.65 +/- 4 microgram/min). None of the children demonstrated a persistent microalbuminuria. This study reveals a high proportion of diabetic children with a persisting glomerular hyperfiltration, without any other symptom of incipiens nephropathy, If elevated GFR plays an important role in the development of diabetic nephropathy, this study emphasizes the value of regular evaluation of renal function in diabetic children.

Specific intellectual deficits in children with early onset diabetes mellitus.

27 children with early onset (less than 4 years) diabetes (EOD), 24 with late onset (greater than 4.0 years) diabetes (LOD), and 30 sibling controls were compared in their performance on tests of intellectual functioning and school achievement. The results indicated that children with EOD, particularly girls, scored lower than the other groups of diabetic children and siblings on tests of visuospatial but not verbal ability. Many of the children with EOD were also having difficulty at school, and a number were currently receiving special education. Diabetic children with earlier onset had more hypoglycemic convulsions than those with later onset. Regression analyses revealed that duration of illness, age of onset, and hypoglycemic convulsions significantly predicted spatial ability.

The metabolic and hormonal effects of continuous subcutaneous insulin infusion therapy in diabetic children.

To find out whether the concurrent metabolic and hormonal abnormalities are corrected when normoglycaemia is achieved, two groups of diabetic children (newly-diagnosed and chronically-treated) were treated with insulin pumps. Fasting levels of metabolites, lipids and hormones were measured before and after 8 to 10 days of pump treatment and the immediate postprandial hormonal and metabolic changes after a test-meal were also measured. Restoration of normoglycaemia was accompanied by correction of multiple metabolic abnormalities including the normalisation of fasting plasma free insulin, growth hormone, free fatty acid, triglyceride and total cholesterol levels. Plasma glucagon, however, decreased below normal, and significant hypoketonaemia developed in newly-diagnosed diabetic children. The fall in (VLDL + LDL)-cholesterol levels was accompanied by a substantial increase in HDL2-cholesterol concentration in newly-diagnosed diabetic children, whereas pump-treatment resulted in a decrease of the HDL3-cholesterol subfraction in chronically-treated diabetic children. The postprandial blood glucose and free insulin profiles were similar to that of control subjects, but there was an "abnormal" postmeal fall in plasma glucagon and free fatty acid levels. These changes together with the fasting hypoglucagonaemia and hypoketonaemia indirectly suggest that optimal glycaemic control is only achievable at the expense of "increased insulin action" despite the failure to detect peripheral hyperinsulinaemia. Furthermore, the restoration of normoglycaemia and the simultaneous normalisation of the metabolic and endocrine milieu is not entirely possible with this mode of therapy.

The prevalence of microalbuminuria in diabetic children and adolescents and its relation to puberty.

The albumin excretion rate (AER) was studied in two groups of diabetic children and adolescents. Twenty-four-hour AER was studied in 75 children with diabetes for 5 years, in 49 children with diabetes for 10 years, in 55 children with diabetes for 10-20 years and in 21 age matched healthy controls. Overnight AER was studied in 129 diabetic children and adolescents with a duration of diabetes varying from 1-14 years. Diabetics exhibited a wide range of AER-values and when expressed per body surface area, diabetic children had significantly higher AER compared to controls. Log transformed AER-values were significantly correlated to age and body surface area in diabetics but not in controls. In the diabetics, log AER was also correlated to systolic and diastolic blood pressure but not to HbA1c. 20% of the diabetics had AER values exceeding the upper value for healthy controls which was 18.5 micrograms/min. 31/35 of them were older than 12 years. In both groups of diabetics, 5% had AER-values exceeding those reported to be predictive for later development of overt nephropathy, the youngest being 16 years old. When comparing diabetic children 0-12 years (i.e. before the maximal growth spurt of puberty) to those older than 12 years, at the same duration of diabetes, the latter group had significantly higher AER-values. No sex difference was found in either age group. It is concluded that after puberty diabetic patients also show evidence of incipient diabetic nephropathy. Thus, routine screening for microalbuminuria is recommended also in pediatric diabetes care after 12 years of age.