Research of practical help

Research of practical help

This section covers just some of the research that has been carried out which may be of practical help in managing your child’s diabetes or which may offer some possible explanations for just some of the mysteries of day to day living with diabetes in your family. However, when looking at research we must always be remember:

• Studies are never the last word on a subject and often more research is necessary before the results should be put into practice.
• Research is often carried out on specific groups of people and therefore the results cannot be extended to assume that the effects will be the same for everybody with a condition or disease.
• Research is often carried out using small numbers of people and this will not necessarily prove a theory or demonstrate all the adverse effects of a treatment or drug. More research with large numbers of participants is necessary.
• Research that is published in reputable journals is peer-reviewed by experts but there is a great deal of research which is not published and not necessarily because it is not good research, therefore we are not receiving the complete picture. In other words there is a publication bias.  

Artificial Sweeteners in drinks for children
Research in children between the ages of 2 and 4 shows that they are close to exceeding the accepted daily intake of saccharin and that the main sources of sweeteners are in concentrated soft drinks like squash.

From July 1996 new legislation came into effect to try to reduce these levels. Sweeteners should no longer be added to normal squashes but only to drinks labelled as ‘sugar free’. There are also rules about dilution so that labels must make it clear how diluted the squash should be. This is particularly important for children with diabetes, and their brothers and sisters, who will all drink sugar-free squash regularly.

Examples of what sort of information should be clearly labelled:

• One part squash to six parts water.
• For toddlers add extra water.
• Labels giving diluting instructions according to the child’s age [obviously this is the best labelling.]

Accuracy of insulin doses in small children
Although most children inject with a pen, for those injecting with  a syringe, the accuracy of the dose is important especially in small children who usually require small doses of insulin. In this case, a small variation on a small amount of insulin could be significant in controlling blood glucose levels and could be the cause of erratic results.

A study published in ‘Diabetes Care’, January 1996 involved ‘caregivers’ of children with diabetes and 10 of these were parents who shared the responsibility of injecting their child. It was found that one person’s estimate of a specific dose was not the same as another and especially with small doses – this varied by about 0.25 units in either direction. This variability occurred in the spouse pairs just as much as the unrelated people and although the study is not recent, the messages still apply.

Clearly this could mean that the child may receive the prescribed dose of insulin but on any given day doses will vary by 0.25 units up or down. This could affect blood sugar levels and account for unexpected results. The researchers offered several possible ways of combating this problem while still enabling parents to share the responsibility of injections:

• One parent always giving the morning injection and the other always giving the evening injection.
• If the parent is going to be away for their usual injection, then pre-fill the syringe or several syringes if necessary.
• If the child goes into hospital then it may be preferable for the parents to give the injections.
• Use a syringe with wider spaces between the markings for greater accuracy – 0.3ml and 0.5ml syringes are available.

Hypoglycaemia in adolescents
A study published in Diabetic Medicine has shown that symptoms of hypoglycaemia vary in adolescents with diabetes compared to adults with diabetes. Hypoglycaemia was induced in 20 adolescents who had diabetes for an average of 5.4 years. All of them had acute autonomic symptoms [classic warnings] although those with tight control had to have lower blood glucose levels before the hypo symptoms occurred. The most common symptoms were hunger, tiredness, feeling weak, feeling warm and trembling. However, the sweating response was absent in the adolescents but not in the adults.

Parental distress affects children with diabetes
Researchers in the US found that behaviour problems in children with Type 1 diabetes are not related to the medical diagnosis of diabetes, but to their mother’s depression and the parental distress at diagnosis. They investigated 114 children with diabetes, 107 children with juvenile arthritis and 88 healthy children. They found that diagnosis of diabetes or arthritis in the children was associated with depression in mothers and distress in both parents. The children did not appear to react to the diagnosis of a serious medical condition but they did react to their parents’ reactions.

Changes in attention with hypo and hyperglycaemia in children with Type 1 diabetes
Researchers in Austria compared the results of a computerised attention test in 38 children with Type 1 in relation to various spontaneously occurring blood glucose levels. The levels used were <3.3mm0l/l, 3.3-8.3mmol/l and 8.3mmol/l. They found that the attention varied significantly with blood glucose levels. The highest number of errors and longest response time was observed during the test run for hypoglycaemia.

The results showed that attention in children with diabetes was significantly reduced compared to the norms for the test. This was especially noticeable during mild hypoglycaemia. These results were not influenced by age, sex, age at diagnosis, metabolic control or the results of the intelligent test. The authors concluded that in children with diabetes a significant reduction in attention was found not only at mild hypoglycaemia but also at low normal blood glucose levels. This shows that attention deficits may occur in children with diabetes even before they are aware of any hypo symptoms.
Eur J Pediatr 1998 Oct; 157[10]: 802-805 

Results from the Yorkshire childhood diabetes register
In June 1999 Diabetes Care published the results of a study that examined the hospital obstetric and neonatal records of 196 children with diabetes who were listed on the Yorkshire Childhood Diabetes Register. Each child with diabetes was matched with two control subjects of the same age and gender. After comparing the 325 control subjects’ hospital records with those of the diabetic children they found that the risk of diabetes is increased in…

• births to older mothers,
• mothers with Type 1 diabetes,
• high blood pressure during pregnancy
• neonatal illnesses.

As in previous studies, they also found that children who are breast fed immediately after birth may develop better defences against Type 1 diabetes.