Endocrinology

Type 1 diabetes, Aristotle and the Jesuits – functional outcomes in childhood predicting adult sequelae

Arguably, the most important developmental outcome of childhood and adolescence is to grow a good brain. A stable supply of glucose is sine qua non for optimal brain development. Type 1 diabetes (T1D) is the exemplar chronic condition of childhood that disrupts blood and tissue glucose delivery. Thus, the assessment of cognitive, psychological, functional and morphological brain outcomes in T1D is apposite.

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100 years of insulin at The Royal Children’s Hospital – pigs, pumps and pluripotent potential

One hundred years ago the first insulin injection was given at RCH. Overnight, type 1 diabetes went from a fatal to a ‘manageable’ condition. Since that time, diabetes management has developed and evolved to a point where in the near future it is hoped that exogenous insulin will represent a treatment failure rather than a therapeutic mainstay. This Grand Round will trace the history of insulin therapy and diabetes management at RCH, and discuss the likely direction of new therapies in the upcoming decades.

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Neurons and growth factors: The good, the bad and the future

The Insulin-like Growth Factor (IGF) system plays a fundamental role throughout the life cycle, acting via both endocrine and paracrine mechanisms. Studies by Prof George Werther and the Endocrine Research team at the Melbourne Children’s Campus have shown that IGF is critical in early development, especially in the brain, where a deficiency leads to marked microcephaly, and it is essential in repair of ischaemic injury.

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The cargo cult of diabetes care: An illustrative dilemma of non-transformative, resource-intensive therapies

Current medical practice is appropriately centred around notions of patient-centred care and personalised medicine. These laudable practices are occurring against a background increasing patient empowerment and disruptive patterns of knowledge transfer. Health care consumers are now interconnected and highly aware of biotechnological advances. Both health care providers and consumers want the latest and “best” in therapies, however all too frequently these therapies are both expensive and non-transformative.

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Bone density and chronic conditions of childhood

Bone health is an important consideration in many chronic health conditions in childhood. Issues of immobility, nutrition, pubertal delay and medication usage may adversely impact bone mass accrual, leading to potentially short and/or long term skeletal fragility, with high attendant morbidity.

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The elephant in the room – type 1 diabetes, adverse brain development and metabolic control

Arguably the pre-eminent developmental task of childhood is to grow a good brain. Glucose is the primary metabolic fuel for the brain- peaking at 140-170 grams per day at around 5 years of age with a constant supply critical for normal cerebral metabolism. Thus it is not surprising that developing brains in early childhood are more susceptible to metabolic insult, particularly those resulting from perturbations in blood glucose levels. Type 1 diabetes (T1DM) is one of the most common chronic diseases of childhood and the condition most likely to cause the greatest fluctuations in blood glucose

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