Predictors of glycemic control and short-term adverse outcomes in youth with type 1 diabetes.

OBJECTIVES: To examine predictors of glycemic control and to assess how glycemic control affects the incidence of short-term adverse outcomes in a pediatric population with type 1 diabetes. STUDY DESIGN: Three hundred youth, aged 7 to 16 years, with type 1 diabetes who were receiving diabetes specialty care were followed up prospectively for 1 year. Treatment plans and frequency of adverse outcomes were ascertained by questionnaires and medical record review. Incidence rates of adverse outcomes were compared among 3 strata of the population, representing tertiles of baseline glycosylated hemoglobin (HbA1c). RESULTS: Blood glucose monitoring frequency was the sole modifiable predictor of HbA1c (P <.0001). Overall incidence rate of hospitalization was 13 per 100 person-years, more than 3 times the rate in the general pediatric population and significantly higher in the upper HbA1c tertile compared with the other strata (P =.001). Rate of emergency department use was 29 per 100 person-years and did not differ significantly among tertiles. Incidence of severe hypoglycemia was 62 per 100 person-years and notably high even in those with poorest glycemic control. CONCLUSION: Despite improvements in diabetes care, the incidence of short-term adverse events in children with type 1 diabetes remains high, particularly in those with poorest glycemic control.

Comparison of eating attitudes and behaviors among adolescent and young women with type 1 diabetes mellitus and phenylketonuria.

The purpose of this study was to assess the eating attitudes and behaviors associated with two chronic diseases that have strong dietary treatment components: type 1 diabetes mellitus and phenylketonuria (PKU). Participants consisted of female campers and staff members who were attending one of two summer camps that specialize in the care of females with type 1 diabetes mellitus (N = 54) and PKU (N = 30). Eating attitudes and behaviors, psychological adjustment, and disease-specific knowledge were assessed using standardized and nonstandardized self-report questionnaires. There was no overall difference in the presence of disordered eating symptomatology between those with diabetes and those with PKU. However, differences in patterns of eating attitudes and behaviors were observed. The data suggest that living with chronic diseases which are treated with dietary management may adversely affect eating attitudes and behaviors and may increase susceptibility to the development of eating disturbances.