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OBJECTIVE:--This study assesses the effects of insulin pump therapy on diabetes control and family life in children 1-6 years old with type 1 diabetes. RESEARCH DESIGN AND METHODS--Twenty-six children with type 1 diabetes for [>/=]6 months were randomly assigned to current therapy (two or three shots per day using NPH insulin and rapid-acting analog) or continuous subcutaneous insulin infusion (CSII) for 6 months. After 6 months, current therapy subjects were offered CSII. Changes in HbA[subscript 1c], mean blood glucose (MBG), hypoglycemia frequency, diabetes-related quality of life (QOL), and parental adjustment were recorded. RESULTS:--Eleven subjects from each group completed the trial (age 46.3 ± 3.2 months [means ± SE]). At baseline, there were no differences between groups in HbA[subscript 1c], MBG, age, sex, diabetes duration, or parental QOL. Mean HbA[subscript 1c], MBG, and parental QOL were similar between groups at 6 months. Mean HbA[subscript 1c] and MBG did not change from baseline to 6 months in either group. The frequency of severe hypoglycemia, ketoacidosis, or hospitalization was similar between groups at any time period. Subjects on CSII had more fasting and predinner mild/moderate hypoglycemia at 1 and 6 months. Diabetes-related QOL improved in CSII fathers from baseline to 6 months. Psychological distress increased in current therapy mothers from baseline to 6 months. All subjects continued CSII after study completion. CONCLUSIONS:--CSII is safe and well tolerated in young children with diabetes and may have positive effects on QOL. CSII did not improve diabetes control when compared with injections, despite more mild/moderate hypoglycemia. The benefits and realistic expectations of CSII should be thoroughly examined before starting this therapy in very young children.

Evidence for Accelerated Rates of Glutathione Utilization and Glutathione Depletion in Adolescents With Poorly Controlled Type 1 Diabetes Dominique Darmaun 1 2 , Shiela D. Smith 1 , Shawn Sweeten 1 , Brenda K. Sager 1 , Susan Welch 1 and Nelly Mauras 1 1 Endocrine Research Department, Nemours Children’s Clinic, Jacksonville, Florida 2 Human Nutrition Research Center, Institut National de la Santé et de la Recherche Médicale (INSERM) U.539, Nantes, France Address correspondence and reprint requests to Dominique Darmaun, MD, PhD, Nemours Children’s Clinic, Research Department, 5 North, 807 Children’s Way, Jacksonville, FL 32207. E-mail: ddarmaun{at}chu-nantes.fr Abstract Depletion of glutathione, an important antioxidant present in red cells, has been reported in type 1 diabetes, but the mechanism of this depletion has not been fully characterized. Glutathione depletion can occur through decreased synthesis, increased utilization, or a combination of both. To address this issue, 5-h infusions of l -[3,3- 2 H 2 ]cysteine were performed in 16 diabetic adolescents divided into a well-controlled and a poorly controlled group and in eight healthy nondiabetic teenagers as control subjects (HbA 1c 6.3 ± 0.2, 10.5 ± 0.6, and 4.8 ± 0.1%, respectively). Glutathione fractional synthesis rate was determined from 2 H 2 -cysteine incorporation into blood glutathione. We observed that 1 ) erythrocyte cysteine concentration was 41% lower in poorly controlled patients compared with well-controlled patients ( P = 0.009); 2 ) erythrocyte glutathione concentration was ∼29% and ∼36% lower in well-controlled and poorly controlled patients compared with healthy volunteers; and 3 ) the fractional synthesis rate of glutathione, although similar in well-controlled and healthy subjects (83 ± 14 vs. 82 ± 11% per day), was substantially higher in the poorly controlled group (141 ± 23% per day, P = 0.038). These findings suggest that in diabetic adolescents, poor control is associated with a significant depletion of blood glutathione and cysteine, due to increased rates of glutathione utilization. This weakened antioxidant defense may play a role in the pathogenesis of diabetes complications. FSR, fractional synthesis rate MPE, mole percent excess Footnotes The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked \"advertisement\" in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Accepted October 4, 2004. Received July 9, 2004. DIABETES