[Juvenile onset diabetes: the effect of education for metabolic control]

This study analyzes the repercusions that education about diabetes and frequent periodical checkups or intensive followups have on the metabolic control of this disease. A group of 13 young diabetics, ranging in age from 5 to 13.4, were submitted to trimestral clinical and analytical controls during a continuous 36-month period starting at the outset of their illnesses. Each received conventional insulin therapy, two daily injections of a mixture of regular insulin/NPH. Annual checkups registered 3.8 +/- 0.4. Four patients, or 30.8%, had an attack of symptomatic hypoglycemia. None of these required hospitalization for ketosis. The HblAc level at the outset of their illnesses was very high, 11.2 +/- 2.7%, but this dropped to normal levels, 7.1 +/- 1.5%, during the first trimester of treatment, and stayed quite normal for the duration of the study except at the 21-month checkup, 8.7 +/- 1.8%, and at the 33-month checkup, 8.6 +/- 1.4%. As soon as metabolic irregularities were detected, all that was necessary so that the succeeding checkups improved notably was to review the items which the patient had neglected such as diet and self-checks. The impact of the initial medical report and the educational component of the periodical checkups seem to be the keys for the quality of a child's metabolical control over time. To sum up, bear in mind that a young diabetic tends to begin to show difficulties in his/her metabolic control about 21 months after the outset of his/her disease, in spite of an intensive checkup program. To a large degree, a solution will depend on the professional competence of the medical team treating the patient, and moreover, on the degree of knowledge about diabetes which the patient and/or his/her family have received.