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This study was designed to evaluate the effects of a self-management training (SMT) program on metabolic control of children with insulin-dependent diabetes mellitus (IDDM) in the first 2 yr after diagnosis. After standard in-hospital diabetes education, 36 children (mean age 9.3 yr, range 3-16 yr) were randomized to conventional follow-up, conventional and supportive counseling (SC), or conventional and SMT, which emphasized use of data obtained from self-monitoring of blood glucose. SC and SMT interventions consisted of seven outpatient sessions with a medical social worker during the first 4 mo after diagnosis and booster sessions at 6 and 12 mo postdiagnosis. Groups were similar with respect to age, sex, body mass index, socioeconomic status, C-peptide, and severity of illness at diagnosis. Metabolic control, measured quarterly by glycosylated hemoglobin (HbA1), improved substantially in all three treatment groups during the first 6 mo. SMT patients had significantly lower HbA1 levels than conventional patients at 1 yr (P less than 0.01) and 2 yr (P less than 0.05) postdiagnosis. SMT patients also had lower HbA1 levels than SC patients, but this did not reach statistical significance. The lower HbA1 levels of SMT patients were not explained by severity of illness at diagnosis, or insulin dose, body mass index, and C-peptide levels at 2 yr. These results suggest that an SMT program during the first few months after diagnosis helps avoid the deterioration in metabolic control often seen in children with IDDM between 6 and 24 mo after diagnosis.

Patients treated with insulin can develop a variety of adverse cutaneous and subcutaneous reactions localized at sites of insulin injection. The reported frequency, severity, and type of skin reactions to insulin are varied, as are the theories relating to their etiology and recommendations for treatment. In this review, several types of localized skin reactions to insulin injection will be described. Particular attention will be devoted to insulin lipoatrophy and skin reactions in patients using mechanical devices for continuous subcutaneous insulin infusion. Recent advances in diabetes care have made insulin-induced lipoatrophy a preventable and treatable disorder. However, localized skin reactions are emerging as a potential problem among users of insulin infusion pumps.