[Outpatient management of diabetic children and adolescents: control of fractional 24-h glucosuria (author's transl)].

The optimal ambulatory treatment of diabetic children requires the cooperation of the patient and his family. Following a careful and extensive information about the course of diabetic mellitus, its management, and its possible complications, the patients and their parents have to take charge of an important part of the metabolic control. Fractionating 24-h-urines in three portions and estimation of the glucose excretion using the Clinitest-method proved to be a valuable tool to judge the metabolic control and to adjust the insulin doses. The comparison of the glucose excretion in 595 fractionated urines of 30 juvenile diabetics estimated with both the Clinitest-method and polarimetry in the clinical laboratory showed good agreement for low glucose conentrations. The discrepancies between the two methods increased with rising glucose concentrations and increasing urine volumes. 139 insulin-dependent diabetic children and adolescents were presented to the Children's Hospital outpatient clinic every 6-7 weeks for a physical examination and measurements of the 24-h-glucose excretions as well as the postprandial blood glucose concentrations. The average glucose excretion in two groups of patients with one or two daily injections of insulin was 24 and 30 g/day, respectively, which is higher than the recommended limit of 20 g/day. The glucose excretion was not significantly influenced by the frequency of insulin administration (one or two injections per day), by the age of the patient or by the duration of the diabetes mellitus. The good agreement of the evaluations of the 24-h-glucosuria using Clinitest on one side and polarimetry on the other proves regular controls at home by the patients and their parents to be useful and to facilitated the outpatients management of juvenile diabetics. Measuring the 24-h-glucose excretion at least 2-3 times a week seems desirable.