RESUMEN
Nineteen insulin-dependent diabetic adolescents who had poor control on twice daily injections and home glucose monitoring participated in a study assessing the feasibility of improved control. Using a randomized crossover protocol, we examined the relative efficacy of continuous subcutaneous insulin infusion and of intensive conventional therapy with three or four daily injections of insulin. Both therapies were regulated with home glucose monitoring. A marked improvement in control with both therapies was observed when mean blood glucose and glycosylated hemoglobin A1 were compared with conventional therapy. However, pump therapy resulted in significantly lower HbA1 than intensive therapy (P less than 0.05), despite a significantly lower total insulin dose (P less than 0.01). We conclude that in adolescents with type I diabetes, continuous subcutaneous insulin infusion is more effective in achieving improvement of diabetes control than is intensive conventional therapy in the outpatient setting.
Asunto(s)
Diabetes Mellitus Tipo 1/tratamiento farmacológico , Adolescente , Glucemia/análisis , Enfermedad Crónica , Ensayos Clínicos como Asunto , Diabetes Mellitus Tipo 1/sangre , Hemoglobina Glucada/análisis , Humanos , Insulina/administración & dosificación , Sistemas de Infusión de Insulina , Insulina de Acción Prolongada/administración & dosificación , Análisis de Regresión , Factores de TiempoRESUMEN
Four patients with diabetes mellitus, optic atrophy, and high-frequency neurosensory hearing loss, two of whom also had diabetes insipidus, are described. The frequency of this syndrome among patients with juvenile diabetes appears to be between 1/148 and 1/175. Because of the progressive nature of the disabilities and the autosomal recessive mode of inheritance, careful monitoring of all juvenile diabetic patients for other signs of the syndrome is warranted.