GOALS OF THERAPY

The major aim of therapy in type 1 diabetic children is the prevention of symptoms of hyperglycemia (osmotic and other symptoms) and prevention of diabetic ketoacidosis as well as hyperosmolar coma (Table 1). Inevitably if the diabetes has been of some duration, most children will exhibit retardation in growth parameters (height, weight and height velocity). Adequate insulin therapy will ensure catch-up growth so that these children can achieve mean growth and development rates, similar to their peers. Along with this there should be a concurrent increase in their exercise capacity and a decrease in the incidence and severity of common infections. Associated with these significant changes is a sense of well being. Until recently, it was debated whether intensive insulin therapy that aims at bringing blood glucose levels to near the normal range is safe and whether it can ameliorate or prevent the development of long term microvascular and macrovascular complications of diabetes mellitus. However, with the publication of few landmark studies like DCCT (2), Kumamoto (3) and UKPDS (4), this debate has been resolved. In DCCT study there was a significant reduction in all components of microvascular disease with good glycemic control (retinopathy-76%, proteinuria-56%, microalbuminuria-46%, neuropathy-61%). However, the results regarding macrovascular disease were not so dramatic and did not reach statistical significance.  

Table 1: Goals of Insulin Therapy