How low can we go...safely?: factors affecting intensive diabetes management.

摘要

Although there is little doubt that the Diabetes Control and Complications Trial (DCCT) was a landmark in the history of diabetes care, pediatric diabetes centers have been understandably cautious in adopting intensive management regimens. Diabetes centers eager to take this approach have seen a consistent decline in HbAlc among their patients but were also faced with an increased occurrence of severe hypoglycemic reactions.1 However, in more recent years, hypoglycemia has been curtailed with the introduction of continuous subcutaneous insulin infusion (CSII)2 and insulin analogues. In addition, the flexibility that these advancements offer has been shown to decrease the perceived burden of diabetes care. This enthusiasm for intensive diabetes management must be tempered, however, with the reality that this approach is more costly and may not be appropriate for every child.