Pediatric Annals

Introductory Comments

Jay S Skyler, MD

Abstract

A symposium on childhood diabetes appeared in the September 1983 issue of Pediatric Annals, with Peter Chase as Guest Editor. That issue covered many important topics related to the epidemiology and management of childhood diabetes. Now, four years later, Dr. Levine deems it appropriate to dedicate another issue to this important disease. I am pleased and honored that he has asked me to serve as Guest Editor. In that assignment, I chose topics that would complement those covered four years ago, while providing the practitioner with useful information. To that end, four subjects have been selected. My colleague, Alex Rabinovitch, and I review current concepts of the etiology and pathogenesis of insulin dependent diabetes mellitus. As most pediatricians are aware, contemporary evidence suggests that immune mechanisms mediate pancreatic islet beta cell destruction and lead to the disease. This forms the basis for potential immune intervention to abort the disease process. In the future, such a strategy may well permit better management of diabetes. In the interim, glycémie control is of the essence, if morbidity and mortality are to be reduced. This is a concept foreign to many pediatricians, since diabetic patients usually do not develop serious complications until they reach adulthood. Nevertheless, what we do early in the disease may be quite important in the later development of complications. Moreover, we can teach good management habits that will last a lifetime. Thus, this symposium includes three relevant articles. In one, I review the rationale for good glucose control. Alicia Schiffrin, Director of the Diabetes Program at Children's Hospital in Montreal, and in my view one of the foremost pediatric diabetologists, addresses her strategy for management of childhood diabetes. This is followed by an article by Robert Tattersall, of Nottingham, England, one of the most astute clinicians I have ever met. In it, he addresses what is probably the most difficult and vexing aspect of diabetes, the psychosocial problems it raises. We trust that you will find this issue useful in your practice.…

A symposium on childhood diabetes appeared in the September 1983 issue of Pediatric Annals, with Peter Chase as Guest Editor. That issue covered many important topics related to the epidemiology and management of childhood diabetes. Now, four years later, Dr. Levine deems it appropriate to dedicate another issue to this important disease. I am pleased and honored that he has asked me to serve as Guest Editor. In that assignment, I chose topics that would complement those covered four years ago, while providing the practitioner with useful information. To that end, four subjects have been selected. My colleague, Alex Rabinovitch, and I review current concepts of the etiology and pathogenesis of insulin dependent diabetes mellitus. As most pediatricians are aware, contemporary evidence suggests that immune mechanisms mediate pancreatic islet beta cell destruction and lead to the disease. This forms the basis for potential immune intervention to abort the disease process. In the future, such a strategy may well permit better management of diabetes. In the interim, glycémie control is of the essence, if morbidity and mortality are to be reduced. This is a concept foreign to many pediatricians, since diabetic patients usually do not develop serious complications until they reach adulthood. Nevertheless, what we do early in the disease may be quite important in the later development of complications. Moreover, we can teach good management habits that will last a lifetime. Thus, this symposium includes three relevant articles. In one, I review the rationale for good glucose control. Alicia Schiffrin, Director of the Diabetes Program at Children's Hospital in Montreal, and in my view one of the foremost pediatric diabetologists, addresses her strategy for management of childhood diabetes. This is followed by an article by Robert Tattersall, of Nottingham, England, one of the most astute clinicians I have ever met. In it, he addresses what is probably the most difficult and vexing aspect of diabetes, the psychosocial problems it raises. We trust that you will find this issue useful in your practice.

10.3928/0090-4481-19870901-05

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