Endocrine Abstracts

The management of type 1 diabetes (T1D) in puberty and adolescence is characterized by special challenges related to the dramatic hormonal, emotional and social changes in the teenage years. It is a period of transition from physical immaturity to maturity and from parental dependency to independence. The daily application of insulin, necessity of frequent selfmonitoring of blood glucose and awareness of diabetic diet represent additional burdens for teenagers with diabetes. It is thus not surprising that blood glucose control is the worst in adolescents compared to younger children and adults with T1D. In addition, adolescents are exposed to physiological puberty-related changes significantly influencing the course of diabetes and its management. Excessive height and weight gain and changes in the GH/IGF1 axis lead to an increase in insulin resistance and enhancements in hepatic glucose production, which are typical for this period of life. The management of T1D during adolescence is complex. The increasing insulin requirement is considerable and insulin doses may need to be increased to more than 1.0 units/kg per day which is the highest relative insulin requirement in life. The need of this amount of insulin can only be successfully achieved with either multiple daily injection (MDI) regimen or with insulin pump (CSII). The use of rapid insulin analogues may provide some advantage by offering a more physiological control of the post-prandial glycemias. Nevertheless, the long-term efficacy of insulin pumps and continuous glucose monitoring systems are limited in non-selected adolescent population. Therefore, a careful selection of suitable patients for this type of therapy is mandatory. Increasing the motivation for compliance to treatment is one of the most important parts of T1D management in adolescents. Multidisciplinary approach including educators, psychologists and dieticians is the basic pre-requisition for successful outcomes.