Childhood diabetes - risk of microvascular complications
Many children and adolescents whose diabetes is not well-controlled are at risk of developing microvascular complications of diabetes, according to a study in the latest issue of the Medical Journal of Australia.
A team of researchers from Paediatric Diabetes Centres in New South Wales (NSW) and the Australian Capital Territory (ACT) conducted an audit of children and adolescents with type 1 diabetes aged under 16 years. The study included over 1000 children with diabetes from urban and rural centres.
The authors said this survey confirms findings from international studies of diabetes control that have shown many children with type 1 diabetes do not have optimal diabetes control. The risk of suboptimal control in the NSW/ACT study increased the longer a child had diabetes, but did not increase with older age itself.
"There were more females (649) in the survey than males (541), which reflects the higher incidence of type 1 diabetes among girls in this population, but there was no difference in their diabetes control. Longer diabetes duration also increased the risk of severe hypoglycaemia (unconsciousness or fitting).
The researchers support the need for further investigation into the quality of life, fears, and coping skills of children and their parents to better understand the barriers to improving glycaemic control. They concluded that this could not happen without an increase in funding for specialists in diabetes in the young to lead and train expert treatment teams
An editorial in the same issue of the MJA, by Dr Jennifer Couper, Head of Diabetes and Endocrinology at the Women's and Children's Hospital in Adelaide, agreed that improvements in glycaemic control are unlikely to improve further without increases in multidisciplinary resources.
"It is especially relevant for more educators to be trained in the unique problems of improving control in this age group, and for their expertise to be available to all children," Dr Couper said.
Dr Couper said that for some diabetic children and adolescents who receive intensive therapy, insulin pumps may provide the best solution, especially for those children with frequent hypoglycaemia or hypoglycaemic unawareness. However, without government subsidy they are not affordable for most families.
The Medical Journal of Australia is a publication of the Australian Medical Association.
CONTACT: (Research) Dr Maria Craig (02) 9350 1111 (B/H)
St George Hospital (0417) 233 064 (A/H)(Editorial) Dr Jennifer Couper (08) 8161 6402 (B/H)University of Adelaide (08) 8271 7302 (A/H)
Sarah Crichton AMA (0419) 440 076