DIABETES IN CHILDREN

EMPHASIS was placed on the primary objective of the physician in planning a therapeutic program for children with diabetes; the promotion of normal growth and development, including intellectual, moral, and social areas. To attain this objective, the physician must provide maximal simplification in his therapeutic plan, so that the pattern of life of the child with diabetes will deviate as little as possible from that of his normal contemporaries. The relationship between level of "control" of diabetes (i.e., approximation to normoglycemia and aglycosuria) and the age of onset of the degenerative changes associated with this disease assumes paramount importance in governing the degree of simplification which can be safely permitted in any therapeutic program. While stressing the fact that such complications ultimately occur no matter what plan of management is pursued, and viewing the evidence on the true relationship between "control" and the appearance of degenerative changes as not yet entirely clear, Read nevertheless considers that all published experimental and clinical studies indicate that better "control" is directly correlated with later onset of degenerative lesions. He therefore believes that the aim of therapy should be to promote an essentially normoglycemic, aglycosuric state, with less than 5 per cent of the daily carbohydrate intake appearing in the urine. With these objectives in mind, Read and Baer described the plan which they currently employ in the treatment of 110 diabetic children at the State University of Iowa, where an average of 1 new diabetic is admitted every 3 weeks. As they practice in a hospital center, they serve on a consultative basis, receiving patients by referral from doctors throughout Iowa. This means initiating regulation of the diabetes and subsequently re-evaluating progress by means of clinic visits 1 to 5 times yearly, at the discretion of the referring physicians.