Intensive insulin therapy by either insulin pump or MDI is safe in children and young adolescents with type 1 diabetes, with similar diabetes control and a very low rate of adverse events. We suggest that both modes be available to the diabetic team to better tailor therapy.

This study was designed to determine the benefit of therapy on final height (FHt) in girls with central precocious puberty (CPP). A total of 102 patients were evaluated – 28 untreated, 26 treated with cyproterone acetate (CyA), and 48 treated with GnRH analogue (GnRHA) – and their achieved FHt was compared to the respective target height (THt). Of the untreated girls, half (14/28) had a slow course of puberty and reached THt ± 0.5 SD (FHt 160.2 ± 7.1, THt 159.5 ± 6.6 cm); the other half (14/28) had an accelerated course of puberty with a FHt well below THt (FHt 150.8 ± 4.3, THt 159.2 ± 5.9 cm) and in most cases (10/14) below the height-SDS of both parents. The treated girls (both regimens) reached THt or above (CyA group: FHt 157.8 ± 5.1, THt 156.8 ± 5. 1 cm; GnRHA group: 159.6 ± 6.3, THt 157.7 ± 5.7 cm). We conclude that without treatment the FHt of girls with CPP may be significantly compromised and that therapy is more beneficial if started before bone age exceeds 12 years. Our data also showed that for final height predictions in CPP the Bayley and Pinneau tables for average children should be used, regardless of the advanced bone age of the patients.

Objective: To compare glycemic patterns by mode of therapy in children with type 1 diabetes mellitus using the Continuous Glucose Monitoring System (CGMS).Design: Open randomized crossover comparing 3 1 ⁄2 months of multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII).Setting: Tertiary care, university-affiliated medical center.Patients: Twenty-three children and adolescents with type 1 diabetes mellitus. Interventions:The CGMS was applied for 72 hours after 1 month and at the end of each study arm. Main Outcome Measures:Hemoglobin A 1c levels and glucose level profiles were compared between the 2 study arms and the 2 sensor applications for each arm.Results: The arms were similar for mean (SD) hemoglobin A 1c levels (CSII, 8.0% [0.8%]; and MDI, 8.2% [0.8%]) and glucose levels. Areas under the curve were significantly larger during MDI for nocturnal and 24-hour hypoglycemia (P=.01 and .04, respectively) and for postprandial hypoglycemia and hyperglycemia (P=.03 and .05, respectively). The rate of hyperglycemia increased during CSII (P =.03), but 24-hour duration and area under the curve for hyperglycemia were similar. Compared with the first CGMS reading in each arm, the second had a longer mean duration of postprandial withintarget glucose levels (P=.04), tendency for lower rate of diurnal hypoglycemic events (P=.1), shorter duration of nocturnal hypoglycemia (P=.05), and smaller 24-hour area under the curve for hypoglycemia (P =.04). Conclusions:Intensive treatment with CSII seemed to be associated with slightly better prebreakfast, postprandial, and within-target glucose profiles than MDI, as well as a smaller area under the curve for hypoglycemia. Lower hypoglycemia-related variables in the second sensor reading in each arm indicate that the CGMS may serve as an educational tool to decrease the rate and magnitude of hypoglycemia.

No abstract

A group of 223 insulin-dependent diabetic patients, aged 7-24 yr, who had been under the regular care of our clinic up to 15 yr, were rated by two independent judges on a two-level scale of adjustment and maladjustment. The patients were divided into two groups. Group A (N = 107) comprised those who had been under care from diagnosis of the disease and had been subjected to the special crisis intervention program offered to every family upon referral of a newly diagnosed patient. Group B (N = 116) comprised patients who were diagnosed and treated initially in a clinic that had no crisis intervention program. Significant differences between the two groups were found in respect to three of the four aspects studied, i.e., compliance, familial relationships, and sociability, with group A showing a better adjustment than group B. There was no significant difference in the fourth aspect studied, i.e., school achievement and work performance. It was found that it took three times the effort, i.e., the time invested in counseling and psychotherapeutic measures, to bring group B to a good level of adjustment than it did to achieve similar results with group A. It is suggested that the initial period after diagnosis of diabetes in a child should be considered a period of crisis, requiring special multidisciplinary services to reduce future psychosocial maladjustments and improve compliance.