Background: Recent years have been marked by numerous advances in the quality of type 1 diabetes care. However, glycemic control remains suboptimal for many patients with type 1 diabetes. The aim of our study was to identify factors associated with poor glycemic control in type 1 diabetic patients. Methods: We studied in a retrospective manner, 188 type 1 diabetic patients, admitted to our department then followed up for at least one year. Results: There was a negative correlation between age at diabetes onset and HbA1c value (p=0.02). Adolescents had higher HbA1c value than adults (10.8±2.9% vs. 9.2±2.8%, p=0.02). No relationship was found between number of daily insulin injections and mean HbA1c value. Mean HbA1c was higher in patients with poor compliance to insulin therapy (11.1±3.3% vs. 8.9±2.4%, p<0.0001), in those with less than 3 clinic visits per year (10.7±3.5% vs. 9.0±2.1%, p=0.001), in subjects with lipohypertrophy (10.9±2.5% vs. 9.2±3.4%, p=0.008) and those with known celiac disease (14.5±5.2% vs. 9.6±2.9%, p=0.005). Conclusion: Several factors were associated with poor glycemic control in our type 1 diabetic patients. Most of them can be changed in particular by strengthening education strategies.

Testicular adrenal rest tumours (TARTs) have been described in patients with congenital adrenal hyperplasia (CAH). The aim of the study was to determine the prevalence of TARTs in patients with CAH, the associated factors and their impact on gonadal function. It is a prospective study concerning six young adult men with CAH, four cases with 21-hydroxylase deficiency and two cases with 11-hydroxylase deficiency. All patients were under glucocorticoid therapy. The mean age was 25 years (range: 20-31). All patients underwent a physical examination with testicular palpation, scrotal ultrasonography, a blood sample for serum testosterone, FSH, LH, inhibin B, ∆4-androstenedione and 17-OH-progesterone measurements and a semen analysis. Ultrasound revealed TARTs in four patients; three were bilateral. The mean tumour size was 6.3 ml (range: 0.02-14.1). The tumours were palpable in two cases. 17-OH-progesterone was <10 ng/ml in all cases. Decreased testosterone level was found in one case. The semen analysis revealed azoospermia in one case and poor semen quality in four patients. TARTs were common and associated with impaired spermatogenesis.

In patients with adrenal insufficiency, fasting can cause complications especially if the level of knowledge about the disease is low.

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