Improved diabetic control in a district general hospital clinic.

A clinic for diabetic children was established in 1983 in a district general hospital to coordinate the changeover to a standard 100 unit insulin regimen. The children's progress was monitored for the next three years. Glycated haemoglobin A1 (HbA1c), measured at the same time each year, fell from a mean (SD) of 15.8 (4.7)% to 9.9 (2.6)% over the three years. A similar degree of improvement was seen when newly diagnosed patients were excluded from the analysis. This improvement was associated with a rise in mean (SD) insulin dosage from 0.89 (0.29) U/kg/day to 1.17 (0.35) U/kg/day. Good control was achieved more easily in children who had been diabetic for less than two years and in those who were prepubertal (particularly boys). A combination of isophane and soluble insulin appeared to be more effective than zinc and soluble insulin in maintaining good control. Ten complications of diabetes were noted in eight patients from 5.2 to 12.4 years after diagnosis. These results show that setting up a diabetic clinic for children in a district general hospital had a beneficial effect on the quality of diabetic control and such improvement may help to reduce the incidence of diabetic complications.