Fifty Years of Practical Clinical Research in the Pediatric Diabetology Center in Brussels that has Consistently had the Lowest HbA1c Values in the 4 Studies (1994-2009) by the Hvidoere International Study Group on Childhood Diabetes
Abstract:
My center in Brussels has consistently had the lowestHbA1c values in the 4 studies (1994-2009) by the Hvidoere International Study Group on Childhood Diabetes. The so-called Dorchy’s recipes, in practice, have been published elsewhere. They are based on decades of experience from clinical studies summarized in this review. They concern the young type 1 diabetic patients followed by my multidisciplinary team in Brussels. They have allowed to improve: HbA1c Levels It is inadequate to systematically assign the multiple injection regimen, or the pump therapy to “intensive” treatment, and some forms of the twice-daily injection regimen, abusively called “conventional”, to a non-intensified therapeutic category of insulin therapy. Indeed, a multiple injection regimen, or the use of pumps, not associated with a good intensified and complete education, as well with the application of the consecutive knowledge, may have deleterious effects on HbA1c. The conclusion is: be dogmatic about outcome, but flexible in approach. Biological variation of glycation and mean blood glucose have greater influence on HbA1c levels than glucose instability. Quality of Care The diet of young people with a type 1 diabetes must be normal and flexible. In many industrialized countries, the proportion of carbohydrates must be increased at the expense of that of fats. The uptake of glucose persists after physical exercise, with a risk of hypoglycemia. To achieve sports performances similar to those of non-diabetics, an optimal HbA1c must be obtained. Screening for Subclinical and Reversible Complications before Irreversible Lesions To prevent or delay the onset of complications we have sought subclinical anomalies using sensitive methods before the onset of irreversible lesions (retinal fluorescein angiography, nerve conduction velocities, micro-albuminuria and β2-microglobulinuria, etc). The discovery of reversible anomalies further motivates patients to improve HbA1c levels. The most interesting predictive marker of subclinical complications is the dosage of hs-CRP, before the CT/HDL-c ratio. Low serum erythrocyte magnesium content and low T3 syndrome are related to glycemic control. Quality of Life and Alexithymia The better the glycemic control, the better the well-being. Family cohesiveness and maternal alexithymia have an impact on glycemic control. We showed, for the first time, that children who have difficulties in expressing their feelings to others are more at risk of poor glycemic control.
