Haller, M. J., Stalvey, M. S., & Silverstein, J. H. (2004).Journal of Pediatrics, 144, 660-661.

These researchers wanted to study the effect of insulin regimen on metabolic control in children. This topic is important, because while optimal control of blood glucose is a goal for children with diabetes, diabetes management can be labor intensive, and multiple factors influence diabetes control. In addition, providers are often at a loss to identify which programs are more successful at achieving good diabetes control. This was a study done with 229 children, 9 to 15 years, attending a diabetes camp. Diabetes control was assessed through measurement of HbA1C levels. Results showed that increased frequency of blood glucose monitoring correlated with improved diabetes control. Conversely, increased number of insulin types used, and older age of the child, correlated with poorer diabetes control. It is certainly no surprise that children who were more diligent with monitoring blood glucose levels had better diabetes control. However, it was unexpected that multiple types of insulin resulted in worse diabetes control. Although clinicians often prescribe a variety of treatments to improve disease management, this study illustrates that a complex regimen may be confusing and counterproductive. Particularly with adolescents, nurses should develop a straightforward plan that is altered only when necessary, in collaboration with the teen and family. In addition, other factors that are related to disease management, such as socioeconomic status, culture, and family structure, must be considered.

Comment by Terri H. Lipman