Furthermore, hypoglycemia unawareness increases with disease duration, and hypoglycemia-related mortality probably follows a similar trend. However, with time, the threat of micro- and macrovascular complications far exceeds that of DKA and hypoglycemia. Knowledge of the relationship between control and complications obtained through the DCCT and other studies allows us to provide patients and their families with the rationale for excellent metabolic control from day I of their diabetes. This needs to be tempered against the age and maturity of the child, their experience with hypoglycemia, and a host of other factors. We also need to provide these young people with counseling in regard to prevention of smoking, support for active lifestyles and avoidance of obesity, surveillance for both hyperlipidemia and hypertension, and screening for early microvascular changes.
Many questions remain unanswered.
While early data suggested that the prepubertal years may be relatively risk-free, more recent information is not as encouraging. These and other issues will keep the diabetes research community busy for many years. One could reasonably speculate that children being diagnosed today with type 1 diabetes face an even more optimistic future. All Rights Reserved. All rights reserved.