title: [(R)evolution in pediatric diabetology].
abstract: Before the discovery of insulin 87 years ago, all diabetic children died within a few weeks or months following diagnosis. Since then, improvements in the treatment and live of young diabetics have sometimes occurred in (r)evolutions that have caused debate among physicians. They are briefly reviewed in this paper. Today's young diabetics, properly trained in self-monitoring and self-treatment, are as competitive physically and intellectually as their non-diabetic peers provided their glycemic control (i.e., their glycated hemoglobin levels) is kept close to normal. They escape the potentially incapacitating complications associated with chronic hyperglycemia of several decades' duration: blindness, renal failure, amputations, excess cardiovascular mortality, etc. To achieve this favourable outcome, diabetic children should be followed by multidisciplinary teams that include pediatric diabetologists and have a large enough case load to acquire a high level of expertise. Quality of care and patient well-being should be compared across teams with the goal of optimizing both these parameters. Any dogmatism must be avoided. The international comparisons of the Hvidøre Study Group on Childhood Diabetes have shown that diabetic children and adolescents on twice-daily free-mix regimens have significantly lower HbA1c than those on basal-bolus, pumps or twice-daily premixed/insulin regimens. Attempts to prevent type 1 diabetes are under way: vitamin D supplementation, avoidance of beta-casein (cow's milk hypothesis), etc. A definitive cure for type 1 diabetes mellitus is difficult to foresee.
authors.affiliation: Clinique de Diabétologie, Hôpital Universitaire des Enfants Reine Fabiola, ULB, Bruxelles. hdorchy@ulb.ac.be
authors.forename: Harry
authors.initials: H
authors.lastname: Dorchy
mesh_terms: D000293:Adolescent; D002648:Child; D002986:Clinical Trials as Topic; D003922:Diabetes Mellitus, Type 1 / Q000266:history / Q000628:therapy*; D006442:Glycated Hemoglobin / Q000032:analysis; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D015337:Multicenter Studies as Topic
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human