Overall health in youth with type 1 diabetes

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Type 1 diabetes mellitus is an important chronic disease of childhood. The focus of pediatricians and parents is often on glucose control, and substantial effort goes into appropriate diet and treatment with insulin. However, in this process of achieving the best glucose control, sometimes other health concerns may be forgotten. In this issue of The Journal, papers by Hofer et al and Svoren et al and an editorial by Zeitler and Klingensmith address these important issues. Hofer et al found that smoking was common in patients age 15-20 with type 1 diabetes. Further, they demonstrated that those who were smokers had worse metabolic control and a worse cardiovascular risk profile than nonsmokers. Svoren et al report that fewer than 25% of youth with type 1 diabetes have sufficient serum levels of vitamin D. This may place many youth with type 1 diabetes at risk for future fractures, especially because diabetes is already associated with multiple other risk factors for skeletal fragility. Zeitler and Klingensmith emphasize that the care for children and adolescents with type 1 diabetes must focus on a wide range of health concerns beyond chronic management of diabetes. This is a strong argument for the Pediatric Medical Home concept, which would provide pediatricians in primary care and pediatric subspecialists with more resources and better organization to improve management of chronic disease and overall health, including prevention.