title: [Evaluation of an intensive treatment education program for type 1 diabetes in a group of adolescents. A two year follow up].
abstract: During the past decade several reports were published showing that intensive treatment of type 1 diabetes can prevent and delay disease-related microvascular complications. However, several problems were reported in children and adolescents such as frequent hypoglycemic episodes and weight gain. The aim of this study was to describe the results of intensified treatment for type 1 diabetes in a group of Argentinean adolescents after a follow-up of two years. Twenty five adolescents with type 1 diabetes older than 10 years with at least one year from diagnosis were selected. All patients received a one-week teaching program during admission to our center. All patients were followed-up monthly during two years. Treatment schedule included 4-5 controls in fasting conditions, two doses of NPH insulin and four doses of regular insulin according to glycemia and the amount of calculated carbohydrate intake. Median age was 13.5 years (range 10 to 19 years). Mean time from diagnosis to inclusion in the study was 3.8 years (range 1.25 to 9 years). Mean total dose of NPH insulin decreased significantly when measured at the inclusion in the study (0.9 IU/kg) and after a year of follow-up 0.8 IU/kg (p 0.04). However, there were no changes in NPH insulin dose after two years follow-up (0.85 IU/kg). On the contrary, the dose of regular insulin administered on fasting conditions with normal glycemia increased from 0 to 0.21/kg after a year (p 0.0001) and to 0.69 after two years (non significant). Median HbA1C showed a significant reduction from 10 +/- 1.62% to 8.53 +/- 1.04% after a year (p 0.03) and to 8.72 +/- 0.81% after two years. BMI Z score increased from significantly from 0.7 +/- 0.9 to 1.06 +/- 1.15 after a year (p 0.03) with a further reduction without a significant difference from the basal value after two years. We found no significant differences in the frequency of hypoglycemia or other metabolic features. Our results show that intensive treatment of type 1 diabetes in children and adolescents can achieve significant and sustained reductions of HbA1C without increasing the risk of hypoglycemia or other adverse effects.
authors.affiliation: Servicio de Nutrición, Hospital Nacional de Pediatría Juan P. Garrahan, Buenos Aires, Argentina.
authors.forename: Andrea G
authors.initials: AG
authors.lastname: Krochik
authors.forename: Carmen S
authors.initials: CS
authors.lastname: Mazza
authors.forename: Maria B
authors.initials: MB
authors.lastname: Araujo
authors.forename: Irina
authors.initials: I
authors.lastname: Kovalskys
authors.forename: Blanca
authors.initials: B
authors.lastname: Ozuna
authors.forename: Daniel
authors.initials: D
authors.lastname: Assad
authors.forename: Liliana
authors.initials: L
authors.lastname: Coppola
authors.forename: Irene
authors.initials: I
authors.lastname: Domenech
authors.forename: Elba
authors.initials: E
authors.lastname: Lahera
authors.forename: Zulma
authors.initials: Z
authors.lastname: Zufriategui
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Gagliardino
mesh_terms: D000293:Adolescent; D000328:Adult; D001118:Argentina; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D002648:Child; D003422:Critical Care / Q000379:methods* / Q000592:standards; D003922:Diabetes Mellitus, Type 1 / Q000178:diet therapy / Q000188:drug therapy*; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007336:Insulin, Isophane / Q000627:therapeutic use*; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D015397:Program Evaluation; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D004040:Dietary Carbohydrates; D007336:Insulin, Isophane