A follow-up study of 1966 patients with insulin-dependent diabetes mellitus (IDDM) who were diagnosed at Children's Hospital of Pittsburgh (CHP) between 1950 and 1981 has been completed. The mean age of the population at follow-up was 21.2 yr with a mean duration of IDDM of 12.9 yr. Nine percent of the patients were deceased, a sevenfold excess in mortality compared with the U.S. population. The relative increase in mortality was greater for females than males and greater for blacks than whites. Before age 20, the primary excess in mortality was at onset of IDDM, or within 6 mo after onset, and was due to acute diabetic complications. After age 20, the annual mortality risk was approximately 2%, which was more than 20 times greater than for the U.S. population. Renal disease was responsible for the majority of these deaths. There was a reduced risk of dying for diabetic patients who were diagnosed between 1966 and 1971 compared with patients diagnosed during earlier years.

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To ascertain whether the dawn phenomenon occurs in normal adolescents and, if so, to determine its mechanism, we measured nocturnal plasma glucose, insulin, glucagon, growth hormone, cortisol, and adrenocorticotropic hormone (ACTH) levels between 01.00 and 08.00 h in 10 healthy adolsescents. The prehepatic insulin secretion rate was calculated based on C peptide levels. The metabolic clearance rate of insulin (MCRI) was calculated as the ratio of mean insulin secretion rate to mean insulin concentration. There was no change in plasma glucose, insulin, and glucagon between 01.00–04.00 and 05.00–08.00 h (paired t test). The MCRI was higher at 05.00–08.00 h compared to 01.00–04.00 h (9.30 ± 1.50 vs. 4.87 ± 1.11 ml·kg^-1·min^-1; p = 0.008). The prehepatic insulin secretion increased at 05.00–08.00 h relative to 01.00–04.00 h( 1.1 ± 0.2 vs. 0.6 ± 0.1 pmol·kg^-1·min^-1;p= 0.013). Similarly, cortisol and ACTH levels were higher at 05.00–08.00 versus 01.00–04.00 h (323 ± 33 vs. 102 ± 22nmol/l, p < 0.001; 3.6 ± 0.5 vs. 1.8 ± 0.4 pmol/l, p = 0.006, respectively). Growth hormone was higher at 01.00–04.00 versus 05.00–08.00 h (7.6 ± 1.2 and 3.0 ± 0.9 µg/l; p = 0.019). ACTH correlated with MCRI (r = 0.66; p = 0.002) and prehepatic insulin secretion (r = 0.75; p < 0.01). We conclude that (1) the dawn phenomenon, characterized by an increase in MCRI, occurs in healthy adolescents; (2) this increase in MCRI is compensated for by an increase in insulin secretion from the normal pancreas, thus preventing a fall in plasma insulin and a rise in plasma glucose.

Studies were designed to assess the accuracy of urine glucose testing in a sample of juvenile diabetic subjects, and to determine the effects of a visual discrimination training procedure on the accuracy. In the first study, each of 81 juvenile-diabetic children was presented three prepared glucose solutions and asked to determine the glucose concentration using the 2-Drop Clinitest method. Results showed errors in 54.3% of the judgments, with greatest difficulty occurring with 1-g/dl concentrations. The majority of errors were false negatives. Study II involved similar testing accuracy on a sample of 10 nurses and 2 research technicians, before and after a visual discrimination training procedure. Results showed that the subjects were incorrect on 39% of the trials initially, with a reduction in the error rate to less than 19% after training.