In a cohort study, Beate Karges and colleagues find that the association between low hemoglobin A1C and severe hypoglycemia in children and young adults with type 1 diabetes has decreased over the period between 1995 and 2012. Please see later in the article for the Editors' Summary

Children and adolescents from a paediatric department specialising in diabetes management report good health-related quality of life. Younger age, good metabolic control and intensified insulin therapy are associated with a better health-related quality of life. Dimensions of health-related quality of life appear to play different roles at different ages, emphasising the importance of the multidimensional health-related quality of life concept and the value of age-appropriate self-reports.

Aims  To investigate psychosocial aspects of continuous subcutaneous insulin infusion (CSII) therapy in children with Type 1 diabetes and to identify relevant and sensitive measures. Methods  We performed a multi‐centre prospective pre‐/post‐study with children (53 girls, 64 boys, age 10.5 ± 3.7 years, mean ± sd) with Type 1 diabetes and their main carer from 18 German diabetic centres. Twenty‐five children aged 8–11 years and 63 adolescents aged 12–16 years and their parents, plus 29 parents of children aged 4–7 years completed standardized questionnaires on generic and diabetes‐specific quality of life (QOL), generic parenting stress, mealtime behaviour, fear of hypoglycaemia and family conflict immediately before and 6 months after transition to CSII. Results  After transition to CSII, diabetes‐specific QOL of children increased significantly (P < 0.001) in all age groups, with moderate to large effect sizes (children aged 4–7 years: Cohen’s effect sized = 1.3; 8–11 years: d = 0.9, adolescents 12–16 years: d = 0.6). Parents reported reduced frequency (P < 0.01, d = 0.4–0.7) and difficulty (P < 0.01, d = 0.3–0.6) of overall parenting stress and decreased worries about hypoglycaemia (P < 0.01, d = 0.4–0.6). Parents of younger children (4–7 years) reported reduced problems with nutrition management (frequency: P < 0.001, d = 1.1; difficulty: P < 0.05, d = 0.7). Conclusions  CSII may have substantial psychosocial benefits. Controlled studies are needed.

Employing a large cohort, this matched-pair analysis has demonstrated over a 3-year study period that CSII is a safe form of intensive insulin therapy with similar glycaemic effects, but with significantly reduced rates of hypoglycaemia and DKA and a lower insulin requirement when compared with MDI.