Abstract
The clinical findings in 27 patients with juvenile-onset diabetes and the effect of pancreatic β-cell function on diabetic stability, including its changes after initiation of insulin therapy, were studied.
All the patients were keto-acidotic at the onset and still require insulin. Their ages were 13.0±0.8 (mean±SEM) years. The degree of stability was quantified by the standard deviation (SD) of eight values of fasting blood sugar (FBS) and by the presence of acetonuria. The SD value was 50.7 mg/dl on the average. The stable group (A) consisted of patients with a SD value of less than 50.7 mg/dl and no acetonuria, and the unstable group (B) consisted of the other patients.
Clinical findings in both groups are as follows:(1) mean age was significantly greater in group A (15.0±1.1 years) than in group B (11.6±1.1 years, P<0.05);(2) age at the onset was significantly greater in group A (13.1±1.0 years) than in group B (6.6±1.1 years, P<0.001);(3) duration of insulin therapy was significantly shorter in group A (1.3±0.5 years) than in group B (5.0±0.8 years, P<0.001);(4) doses of insulin administered were significantlyless in group A (16.4±3.5 units/day) than in group B (35.5±7.2 units/day, P<0.05);(5) CPRvalue was significantly higher in group A (1.62±0.47 ng/ml) than in group B (0.49±0.05 ng/ml, P<0.05). The onset of diabetes peaked at two to three, seven to eight and 11 to 12 years of age.
Age at the onset of diabetes and the CPR value were inversely correlated with the SD value of FBS (P<0.05, respectively). The earlier the age at onset, the lower the CPR value was. Blood glucose was stable in patients with a CPR value of more than 1.16 ng/ml and unstable in those with a CPR value of less than 0.45 ng/ml, indicating that pancreatic β-cell function was important for diabetic stability.
Patients with a short duration of insulin therapy had a high amount of CPR, and those with more than two years of insulin therapy had a CPR value of less than 0.50 ng/ml. Thus, pancreatic β-cell function was thought to be retained for about two years after initiation of insulin therapy.
