Conventional Versus Intensive Diabetes Therapy in Children with Type 1 Diabetes
A study published in the August 1999 issue of Diabetes Care calls into question the wisdom of applying intensive therapy to children with diabetes due to the significantly increased risk of severe hypoglycemia associated with intensive therapy. The study demonstrated that children with diabetes who had received intensive therapy from the time of diagnosis experience three times the number of severe hypoglycemic episodes, performed less accurately on a specific memory-testing task, and performed more slowly on a pattern recognition task compared with kids in the conventional therapy group and kids without diabetes. In many other tests, however, there was no statistical difference among the three groups.
The children with Type 1 diabetes, whether treated with intensive or conventional therapy, performed more slowly on a fine motor speed and coordination test than the kids without diabetes. The authors of the study note that slowed motor speed is common in kids with Type 1 and is related to early onset of the disease.
The authors conclude that some memory impairment may be associated with intensive therapy that is consistent with the effects of severe hypoglycemia. While the authors suggest that more research is needed, their findings, if validated, argue for caution in applying intensive therapy to kids, including adolescents. The benefits of intensive therapy associated with reduction in risk of complications must be weighed against the danger of the increased occurence of hypoglycemia.
An accompanying editoral ("Memory and Metabolic Control in Children") notes that "given our understanding of the correlates and consequences of memory dysfunction in childhood, the implications of this work by Hershey and colleagues are certainly chilling." The issue is whether intensive therapy, which has been shown to reduce the risk of complications, is causing brain damage in kids. Particularly at risk for damage from intensive therapy are kids who are diagnosed in the first 4-6 years of life. The editorial also notes that data from several small studies suggest that brain damage may occur in as little as two years after diagnosis. In summary, the editorial urges more studies and the need to prevent hypoglycemia in children with diabetes, regardless of their therapy.
Full text at http://pediatrics.medscape.com/ADA/DC/1999/v22.n08/dc2208.02.hers/dc2208.02.hers-01.html
(Medscape membership required)
Diabetes Care 22:1318-1324, 1999
Posted July 25, 1999
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