Management of diabetes mellitus in children younger than 5 years of age
M. P. Golden, B. P. Russell, G. M. Ingersoll, D. L. Gray and K. M. Hummer
Optimal treatment for children younger than 5 years of age with
insulin-dependent diabetes mellitus is not well defined. Nineteen young
children with this disease were treated with a program in which frequent
home blood-glucose monitoring was used as the basis for an educational
program emphasizing parental adjustment of insulin in response to current
glucose levels and anticipated diet and exercise. Eleven children were
treated from diagnosis (group I) and another eight (group D) were referred
after less intensive treatment. The mean duration of observation of group I
children was 13.6 months (range, six to 24 months). For group D, the mean
time between diagnosis and referral was 14.9 months (range, seven to 24
months) and 14.6 months (range, six to 24 months) after referral. Before
referral, there were 11 hospitalizations in group D. During the intensified
program there were two hospitalizations in group D and one in group I.
There were 3.3 episodes of severe hypoglycemia per child per 18 months in
group D before referral, 1.7 episodes after referral, and 0.4 episodes in
group I. Ten of 14 severe hypoglycemic episodes during intensified
treatment occurred when there was no or infrequent home blood-glucose
monitoring. Only four episodes seemed to have been unpredictable and
unpreventable. Mean glycosylated hemoglobin levels were higher in group D
patients when compared with both the duration of insulin-dependent diabetes
mellitus and the time of initiation of intensified treatment. Mean daily
insulin doses increased progressively in group I patients following
diagnosis, and were comparable with those in group D patients at 15 and 18
months' duration of illness. Thus, frequency of hospitalization and severe
hypoglycemia can be decreased in young children. Frequent home
blood-glucose monitoring is required and extensive educational and
psychosocial support is necessary for families to implement this intensive
approach. The long-term effects on psychoneurological development need
evaluation.
