H Loeb’s research while affiliated with Centre Hospitalier Universitaire Saint-Pierre and other places

In conclusion, the median risk of developing incipient retinopathy is 8 years (fluorescein leaks only) or 9 years (microaneurysms). The main risk factors are diabetes duration and long-term metabolic control over several years. The mean duration of diabetes preceding the appearance of early retinopathy is shorter by 3 years in girls than in boys while their age at onset of diabetes is higher. Retinopathy is rare before puberty. Progression of retinopathy is unrelated to short-term (1 or 2 years) metabolic control. Regression of incipient retinopathy is possible.

I CONSIDÉRATIONS DE BASE (p497) A La querelle des régimes est (presque) terminée B Besoins caloriques et proportion des nutriments C Distribution des glucides au cours de la journée D Facteurs influençant la réponse glycémique aux aliments E Modification des lipides alimentaires F Aliments spéciaux pour diabétiques II ASPECTS PRATIQUES DE L'ÉDUCATION ALIMENTAIRE DES JEUNES DIABÉTIQUES (p505) A Méthode B Messages à faire passer C Adhésion au régime

Diabetic children should consume the number of calories normal for heir age, with an ideal % nutrient distribution: ±5 % carbohydrate (especially delayed-resorption carbohydrates), ±30 % lipid and ±15 % protein. In some countries e.g. Belgium, the excessive proportion of fat in the diet must be reduced. Calorie requirements may vary a lot from one day to the next, but nutrient fluctuations do not entail proportional changes in metabolic control, as long as insulin adaptation is adequate. It is essential that diabetic children adapt their food intake to heir appetite; they do not have set needs, since they are growing and their physical activity varies. Imposing a weighed and measured diet is neither desirable for diabetic control nor for the psychological factor. A diet which reduces only qlucids automatically favours an excessive supply of lipids which is bad for the blood vessels. A general calorie restriction prevents normal growth and this, in extreme cases, can lead to Mauriac's syndrome. At the other extreme, a disordered diet causes large glycemic fluctuations with hypoglycemic accidents and hyperglycemic spurts responsible for degenerative complications. Dietary democracy, rather han anarchy or authoritarianism, leads to better control of diabetics. The diet must be well-balanced and individually adapted, bearing in mind insulin, physical activity, etc. Where two daily insulin injections are given, what is most important is the distribution of glucides over the various meals. The use of the pen-injector provides for greater freedom in the diet. It must be borne in mind hat the hyperglycemic effect of sucrose is restrained if the sucrose is mixed with proteins and lipids during a meat; some sweets may be allowed even in he absence of intense physical activity or hypoglycemia.. The use of synthetic sweeteners and 'diabetic' diet products, often useless and expensive, is not recommended.

SUMMARY: The measurement of total HbA1 gives an “objective” estimate of the degree of metabolic control of diabetes during the erythrocyte lifespan. 333 assays in 85 young diabetics aged three to twenty-three years showed a mean total HbA1 (upper normal limit: 7.7%) of 10.9 ± 2.6%. HbA1 levels parallel the clinical evaluation of the degree of control. HbA1 concentrations are correlated with the duration of diabetes (r=0.26; p<0.001), triglyceridemia (r=0.22; p<0.001), cholesterolemia (r=0.26; p<0.001) and glycemia (r=0.50; p<0.001). The HbA1/glycemia correlation grows stronger as glycemia increases. This probably reflects the existence of a labile form of HbA1. HbA1 concentrations messured repeatedly over one year were not statistically different with and without retinopathy, probably because the study period was too short. Measurement of HbA1 is also of value in diagnosing non-compliance.

Residual insulin secretion in juvenile diabetes. Relationships with duration of diabetes, metabolic control and retinopathy Summary. This study concerned 74 diabetic children and adolescents, ages ranging from 3 to 21 years. Duration of the disease ranged from 1 month to 15 years. Blood samples were taken during a 12 month period of observation. 292 immunoreactive C-peptide (CPR) evaluations showed a residual endogeneous secretlon of insulin in 57% of cases. CPR and duration of diabetes were negatively correlated (r : -O.35; p < 0.01 ); however, even 5 years after onset of the disease, a residual beta-cell activity could be observed. CPR was not related with blood glucose, triglyceride, cholesterol or glycosylated hemoglobin levels. On the other hand, CPR was statlstically higher in patients whose diabetes had been well-controlled from the onset of the disease, accordinq to clinical criteria, and in those who did not present with retinopathy : however they were also the patients with the shortest duration of disease.

It is clear that severe psychological and social problems are major obstacles in achieving good metabolic control [1 ,2]. Therefore, a strictly medical approach will not allow optimal treatment in most diabetic children and adolescents. Their needs are best met by a multidisciplinary approach [3] . In this paper we would like to draw the outline of our Diabetology Unit.

The importance of diet in the treatment of diabetic children has always been rather controversial.Various diets have been proposed often without scientific foundation. Many authors seem to forget that, ultimately, the main goal of the therapy is to prevent complications by maintaining the highest possible degree of control [1-4) . In 4 clinical studies we tried to determine some nutritional constraints in order to deduce a practical strategy for the dietary education of our diabetic patients.

Conclusion Le métabolisme du cholestérol est mal connu chez les diabétiques. La régulation de la cholestérolémie est multifactorielle et la prudence s'impose lorsqu'on essaie de déterminer l'influence d'un paramètre déterminé. Dans les conditions expérimentales de notre étude (enfants équilibrés de manière satisfaisante sur le plan du diabète et de l'alimentation), nous n'avons pas pu établir de relation entre la cholestérolémie, le degré de contrôle, les apports en lipides, cholestérol, graisses polyinsaturées/graisses saturées. Par ailleurs, la prévalence de la rétinopathie ne semble pas dépendre de la cholestérolémie.

In recent years, it has become increasingly apparent that functional abnormalities precede the structural and irreversible lesions that characterize diabetic complications. We have conducted several studies to investigate subclinical diabetic triopathy in children and adolescents.

During recent years, the paediatric endocrinologists of the Belgian universities have agreed on common guidelines for what they consider optimal management of juvenile diabetes. The aim of this paper is to describe some recent advances in our understanding of insulin-dependent diabetes mellitus, to stress the importance of good metabolic control and more particularly to outline a comprehensive treatment schedule. The therapeutic approach described here is generally accepted not only in Europe but in the USA as well. It is applicable in general paediatric practice and contributes to the 'normal' life of diabetic children.