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Eighteen diabetic children ate three different snacks (free sucrose, sucrose plus fibre, fructose plus fibre) or had no snack on each of 4 mornings. Subsequently 10 children from this group took a standard snack (free sucrose) or no snack on two afternoons. In other respects the day of testing was standardised, the children going to school as normal and collecting their blood spots on filter paper for glucose analysis. There was no difference in the blood glucose profiles between different snacks or when no snack was taken either in the mornings or afternoon. This suggests both that moderate amounts of simple sugar do not have a detrimental effect on glycaemic control and that snacks can generally be omitted without serious hypoglycaemic problems.

Ninety diabetic children each provided at least one 24-hour blood glucose profile at home using an impregnated filter paper strip. The mean 24-hour blood glucose level correlated significantly with urine control, height velocity, and Hb A1. The correlation coefficient for individual blood glucose values (r = 0.61) and for mean 24-hour blood glucose values (r = 0.73) repeated within 14 days showed an acceptable degree of reproducibility for the blood glucose profiles. Mean 24-hour blood glucose values fell significantly overall (11.4 to 9.8 mmol/l; 205 to 176 mg/100 ml) in 47 children who had repeated profiles more than 2 weeks apart. Unrecognised nocturnal hypoglycaemia (less than 3.0 mmol/l; 54 mg/100 ml) was found in 19% of children on twice-daily Semitard insulin. The study shows that children over age 7 years manage home blood glucose monitoring without difficulty. It shows that the results are reproducible and correlate with other indices of control, and that it provides a practical basis for the improvement of diabetic control.

Children with diabetes mellitus are not significantly heavier than their peers, and those who are obese do not have poorer diabetic control.

Height and skeletal maturity scores (TW 2) were determined in 77 diabetic children at diagnosis and again in 48 of them after 1 to 4 years on insulin treatment. Boys, especially those of prepubertal age, were tall at onset. Girls had normal stature, but showed significant growth retardation after treatment. Skeletal maturity was appreciably advanced in both sexes at diagnosis, and on treatment returned to normal only in boys. Girls maintained their advanced skeletal maturity, resulting in an increased disparity between height and skeletal maturity. The results of this study suggest that a prediabetic metabolic abnormality may enhance skeletal maturity in children with diabetes and continues to operate in girls after treatment, despite a reduced growth rate.

Total glycosylated haemoglobin (HbA1) levels were measured in 94 diabetic children aged between 3 and 19 years. The results were compared with traditional methods of assessing blood glucose control. HbA1 levels correlated with home urine glucose testing (P less than 0.05), with 24-hour urine glucose excretion (P less than 0.01), and with height velocity (P less than 0.001). Within the first two of these parameters there was a wide scatter of results, suggesting the inaccuracy of these methods for assessing control. The association of raised HbA1 levels with height velocities less than 10th centile shows the effect of poor control on growth. HbA1 may prove to be an objective method for assessing long-term blood glucose levels in diabetes, and thus it may be possible to determine the effect of good control in the prevention of the various diabetic complications.

Mean values for two variables of the pubertal growth spurt, peak height velocity and age at peak velocity, of children attending the diabetic clinic in Bristol are reported. The growth spurt was normal both in timing and intensity in boys, but the peak velocity was reduced and age at peak velocity more variable among girls.

There was no significant difference in the heights of 66 insulin-dependent diabetic children at diagnosis when compared with age, sex and period-matched controls.