Paediatricscommon
A 14-year-old girl who has had type 1 diabetes since she was eight is reviewed in the paediatric diabetes clinic. Her glycated haemoglobin has risen over twelve months from 58 mmol/mol (7.5 per cent) to 92 mmol/mol (10.6 per cent). She has grown 6 cm and gained 2 kg in that time and has had no admissions and no hypoglycaemia. Her continuous glucose monitor shows readings above 15 mmol/L between midday and four in the afternoon on weekdays only, with in-range readings at weekends and through the school holidays. Coeliac and thyroid screening three months ago were normal. Which one of the following best explains the deterioration?