My child has type 1 diabetes. What is the recommended schedule for testing and treatment for preventative care? For instance, How often should thyroid, adrenal, cholesterol, etc. be tested? Beginning at what age, should preventative treatment be administered? (e.g., statins, ACE inhibitors, etc.) Are there other tests/preventatives that should be done that I am not aware of?

Yours is an important question at a time when laboratory tests are playing an increasing role in the early detection and prevention of the complications of diabetes. There is no set schedule however because it varies with individual circumstances. Assuming however that your son is known to have type 1A (autoimmune) diabetes on the basis of a positive antibody test at diagnosis and that at that time he also had a TSH test for hypothyroidism, an antiglutamyl transferase antibody test for celiac disease, and an anti 21-hydroxylase test for adrenal insufficiency and that he has since been in good control with no fall off in his growth progress then the following schedule would be a common one. This would repeat the TSH test together with ones for serum cholesterol and urine microalbumin annually from the onset of puberty or after five years from the initial tests. A repeat test for celiac disease would also be justified if there was a fall off in growth and unexplained difficulty over control, especially if there were gastrointestinal symptoms; but further testing for adrenal deficiency or for other components of the Autoimmune Polyglandular Syndrome Type II is not necessary unless it is clinically suggested.

Prophylactic treatment with statins and ACE inhibitor should not be given although the latter would be indicated if there was sustained abnormal microalbuminuria irrespective of blood pressure. Statins have not yet been approved in childhood although they have been shown to be effective. At the same time it would be important to be sure that any hypercholesterolemia was not a reflection of hypothyroidism.

As to other tests, you would have to include retinal examination annually preferably with digital photography which permits a very accurate record and can now be done without dilating the pupils.. This is important at a time when non laser treatment of early retinal blood vessel complications is beginning to be possible. In time, this list is likely to expand with the use of simple tests for inflammation like C-reactive protein as early heralds of vascular complications. No testing can replace good control.

DOB

[Editor’s comment: See Aspirin Therapy and The Heart Protection Study (about statins) at the Diabetes Monitor.

WWQ]