The Mystery of Good Metabolic Control in Type 1 Diabetes - Evidence Based Lessons from a Pediatric Clinic

Too few patients with ‘Type 1 diabetes have enough good metabolic control to prevent complications. Residual insulin secretion is important, but also other physiological differences between patients contribute to the degree of blood glucose balance. Still, the treatment plays an important role and the way how the diabetes team work with the patient is absolutely crucial. It is proven that HbA1c can be influenced by intensity of treatment, and also that patients at certain clinics have lower HbA1c than at other clinics. Psychological approach and treatment policy explains some of this difference. Although it is difficult to study such factors in randomized, controlled double-blind studies, we have performed studies giving evidence of the importance of attitudes, goals, how the diabetes team works and what message it conveys. Thus some parts of treatment which could be called “art of medicine”, based on skill, experience, empathy and similar “soft” values should not be neglected.