Impact of home blood glucose monitoring on childhood diabetes.

Ninety diabetic children each provided at least one 24-hour blood glucose profile at home using an impregnated filter paper strip. The mean 24-hour blood glucose level correlated significantly with urine control, height velocity, and Hb A1. The correlation coefficient for individual blood glucose values (r = 0.61) and for mean 24-hour blood glucose values (r = 0.73) repeated within 14 days showed an acceptable degree of reproducibility for the blood glucose profiles. Mean 24-hour blood glucose values fell significantly overall (11.4 to 9.8 mmol/l; 205 to 176 mg/100 ml) in 47 children who had repeated profiles more than 2 weeks apart. Unrecognised nocturnal hypoglycaemia (less than 3.0 mmol/l; 54 mg/100 ml) was found in 19% of children on twice-daily Semitard insulin. The study shows that children over age 7 years manage home blood glucose monitoring without difficulty. It shows that the results are reproducible and correlate with other indices of control, and that it provides a practical basis for the improvement of diabetic control.

Marrow relapse on maintenance chemotherapy in childhood acute lymphoblastic leukaemia.

A retrospective study on 190 children with acute lymphoblastic leukaemia and marrow relapse on therapy demonstrated a universally poor prognosis with a high risk of extramedullary leukaemia. 49.1% of children achieved a second remission, the median duration of haematological remission being 97 days. The median duration of survival was 157 days, with no survivors beyond 2 years 3 months from relapse. Children with high white blood counts at diagnosis, those relapsing early and older children had a particularly poor prognosis. Children who achieved a first remission with difficulty and those receiving regular vincristine and prednisolone in their remission were less likely to achieve a second remission. Those who failed to go back into remission with the more commonly used drugs were not usually responsive to other drugs.