Many adolescents with type 1 diabetes (T1DM) have suboptimal glycaemic control, increasing the risk of diabetic complications. This thesis explores some of the causes, consequences and therapeutic options for adolescents with T1DM and poor glycaemic control. Insulin resistance occurs in T1DM and normal puberty and contributes to poor glycaemic control. The effect of rosiglitazone, an insulin sensitizer, in addition to insulin on the glycaemic control of adolescents with T1DM was tested using a randomized, double blind placebo controlled trial. Treatment with rosiglitazone did not improve HbA1c, however there was a significant reduction in insulin dose and adiponectin, suggesting improved in insulin sensitivity. Insulin sensitivity by euglycaemic hyperinsulinaemic clamp varied widely between individuals and there was no consistent pattern with rosiglitazone. Potential markers of insulin resistance in T1DM were examined. Total and high molecular weight (HMW) adiponectin levels were lower in children and adolescents with T1DM than controls. HMW adiponectin was significantly associated with other markers of insulin resistance, such as insulin dose, body mass index standard deviation score (BMI-SDS), age, pubertal stage and duration of diabetes. There is increasing evidence that insulin resistance may play a role in T1DM complications. The natural history and risk factors for the development of microalbuminuria was described using a retrospective cohort study of 972 children and adolescents. Most cases of microalbuminuria were transient. Apart from baseline albumin excretion rate, HbA1c and age at diagnosis, other predictors of subsequently developing persistent microalbuminuria included several markers of insulin resistance (higher cholesterol, BMI-SDS, and insulin dose). In addition to insulin resistance, there are many other factors that contribute to glycaemic control. The role of the variability in carbohydrate intake was assessed using questionnaires and food diaries. Although carbohydrate consumption varied by approximately 45grams each day, it had no significant correlation with HbA1c. The impact of socioeconomic status, quality of life and health care delivery is discussed by comparing glycaemic control of children with T1DM in three diabetes centres. A model for the factors associated with poor glycaemic control in adolescents with T1DM is proposed, and the challenges of research and clinical practice in this population are discussed.
| Identifer | oai:union.ndltd.org:ADTP/242083 |
| Date | January 2008 |
| Creators | Stone, Monique Lee, Women's & Children's Health, Faculty of Medicine, UNSW |
| Publisher | Publisher:University of New South Wales. Women's & Children's Health |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | http://unsworks.unsw.edu.au/copyright, http://unsworks.unsw.edu.au/copyright |
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