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Update on Medical Management of Diabetes in Children and Adolescents: Epidemiology and Treatment

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Behavioral Diabetes

Abstract

Type 1 diabetes is the predominant type of diabetes occurring in children and adolescents. It has a variable incidence worldwide but continues to increase steadily over time. Type 1 diabetes appears to be an autoimmune condition with serious long-term health consequences. Type 2 diabetes is much less common, but its incidence is rising in parallel to the worldwide rise in childhood obesity. Although diabetes is a disorder of glucose metabolism with serious disruption of biochemical pathways, its management depends more on psychosocial or behavioral factors and indirectly on the social determinants of health. Important factors in this regard include access to care, in the context of an interdisciplinary team; acquisition of the knowledge needed to navigate the day-to-day challenges of living with diabetes; technical skills which allow knowledge application; nutritional planning; and psychosocial surveillance and intervention when necessary. The setting of realistic goals that are both achievable but importantly protect from the onset or progression of complications is essential. Avoidance of diabetic ketoacidosis and severe hypoglycemia are attainable goals, though when they do occur, they require expert management. The outcomes in type 1 diabetes have been steadily improving under these circumstances.

The author has no disclosures or conflicts of interest to declare.

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References

  • Amed, S., Dean, H. J., Panagiotopoulos, C., Sellers, E. A., Hadjiyannakis, S., Laubscher, T. A., … Hamilton, J. K. (2010). Type 2 diabetes, medication-induced diabetes, and monogenic diabetes in Canadian children. Diabetes Care, 33(4), 786–791.

    Article  Google Scholar 

  • Arif, S., Leete, P., Nguyen, V., Marks, K., Nor, N. M., Estorninho, M., … Dunger, D. B. (2014). Blood and islet phenotypes indicate immunological heterogeneity in type 1 diabetes. Diabetes, 63(11), 3835-3845.

    Article  Google Scholar 

  • Bui, H., To, T, Stein, R., Fung, K., & Daneman, D. (2010). Is diabetic ketoacidosis at disease onset a result of missed diagnosis? The Journal of Pediatrics, 156(3), 472–477.

    Article  Google Scholar 

  • Cameron, F. J., Northam, E. A., Ambler, G. R., & Daneman, D. (2007). Routine psychological screening in youth with type 1 diabetes and their parents. Diabetes Care, 30(10), 2716-2724.

    Article  Google Scholar 

  • Cameron, F. J., & Wherrett, D. K. (2015). Care of diabetes in children and adolescents: Controversies, changes, and consensus. The Lancet, 385(9982), 2096-2106.

    Article  Google Scholar 

  • Craig, M. E., Jefferies, C., Dabelea, D., Balde, N., Seth, A., & Donaghue, K. C. (2014). Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatric Diabetes, 15(Suppl 20), 4–17.

    Article  Google Scholar 

  • Dabelea, D., Bell, R. A., D’Agostino, R. B., Jr., Imperatore, G., Johansen, J. M., Linder, B., … Pettitt, D. J. (2007). Incidence of diabetes in youth in the United States. JAMA, 297(24), 2716-2724.

    Article  Google Scholar 

  • Dabelea, D., Mayer-Davis, E. J., Saydah, S., Imperatore, G., Linder, B., Divers, J., … Liese, A. D. (2014). Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA, 311(17), 1778–1786.

    Article  Google Scholar 

  • Daneman, D. (2006). Type 1 diabetes. The Lancet, 367(9513), 847–858.

    Article  Google Scholar 

  • Daneman, D., & Nakhla, M. (2011). Moving on: Transition of teens with type 1 diabetes to adult care. Diabetes Spectrum, 24(1), 14–18.

    Article  Google Scholar 

  • Diabetes Control and Complications Trial (DCCT). (2016). Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular outcomes in type 1 diabetes: the DCCT/EDIC study 30-year follow-up. Diabetes Care, 39(5), 686–693.

    Article  Google Scholar 

  • Diabetes Control and Complications Trial Research Group. (1993). The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The New England Journal of Medicine, 1993(329), 977–986.

    Google Scholar 

  • DiMaglio, L. A., Acerini, C. L., Codner, E., Craig, M. E., Hofer, S. E., Pillay, K., & Maahs, D. M. (2018). ISPAD Clinical Practice Consensus Guidelines 2018: Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes. Pediatric Diabetes, 19(Supplement 27), 105–114.

    Article  Google Scholar 

  • Eisenbarth, G. S. (1986). Type I diabetes mellitus. New England Journal of Medicine, 314(21), 1360–1368.

    Article  Google Scholar 

  • Gale, E. A. M. (2005). Type 1 diabetes in the young: The harvest of sorrow goes on. Diabetologia, 48, 1435–1438.

    Article  Google Scholar 

  • Harron, K. L., Feltbower, R. G., McKinney, P. A., Bodansky, H. J., Campbell, F. M., & Parslow, R. C. (2011). Rising rates of all types of diabetes in south Asian and non-south Asian children and young people aged 0–29 years in West Yorkshire, UK, 1991–2006. Diabetes Care, 34(3), 652–654.

    Article  Google Scholar 

  • Inman, M., Daneman, D., Curtis, J., Sochett, E., Clarke, A., Dunger, D. B., … Mahmud, F. H. (2016a). Social determinants of health are associated with modifiable risk factors for cardiovascular disease and vascular function in pediatric type 1 diabetes. The Journal of Pediatrics, 177, 167–172.

    Article  Google Scholar 

  • Inman, M., Daneman, D., Curtis, J., Sochett, E., Elia, Y., Dunger, D. B., … Mahmud, F. H. (2016b). Assessing social determinants of health in a pediatric diabetes clinical research trial: Are recruited subjects representative of the larger clinical population? Diabetes Research and Clinical Practice, 113, 41–43.

    Article  Google Scholar 

  • Jefferies, C. A., Nakhla, M., Deraik, J. G., Gunn, A. J., Daneman, D., & Cutfield, W. S. (2015) Preventing diabetic ketoacidosis. Paediatrics Clinics of North America, 62, 857–871.

    Google Scholar 

  • Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. (2009). The effect of continuous glucose monitoring in well-controlled type 1 diabetes. Diabetes Care, 32(8), 1378–1383.

    Article  Google Scholar 

  • Kondrashova, A., Seiskari, T., Ilonen, J., Knip, M., & Hyöty, H. (2013). The ‘hygiene hypothesis’ and the sharp gradient in the incidence of autoimmune and allergic diseases between Russian Karelia and Finland. APMIS, 121(6), 478–493.

    Article  Google Scholar 

  • Kordonouri, O., Klingensmith, G., Knip, M., Holl, R. W., Aanstoot, H. J., Menon, P. S., & Craig, M. E. (2014). Other complications and diabetes-associated conditions in children and adolescents. Pediatric Diabetes, 15(Suppl 20), 270–278.

    Article  Google Scholar 

  • Limenis, E., Shulman, R., & Daneman, D. (2012). Is the frequency of ketoacidosis at onset of type 1 diabetes a child health indicator that is related to income inequality? Diabetes Care, 35(2), e5.

    Article  Google Scholar 

  • Miller, R. G., Secrest, A. M., Sharma, R. K., Songer, T. J., & Orchard, T. J. (2012). Improvements in the life expectancy of type 1 diabetes. Diabetes, 61(11), 2987-2992.

    Article  Google Scholar 

  • Nakhla, M. M., & Daneman, D. (2012). Transitions in the care of children and youth with type 1 diabetes. Diabetes Management, 2(6), 537–547.

    Article  Google Scholar 

  • Newhook, L. A., Penney, S., Fiander, J., & Dowden, J. (2012). Recent incidence of type 1 diabetes mellitus in children 0–14 years in Newfoundland and Labrador, Canada climbs to over 45/100,000: A retrospective time trend study. BMC Research Notes, 5(1), 628.

    Article  Google Scholar 

  • Patterson, C., Guariguata, L., Dahlquist, G., Soltész, G., Ogle, G., & Silink, M. (2014). Diabetes in the young–a global view and worldwide estimates of numbers of children with type 1 diabetes. Diabetes Research and Clinical Practice, 103(2), 161–175.

    Article  Google Scholar 

  • Patterson, C. C., Dahlquist, G. G., Gyürüs, E., Green, A., Soltész, G., & EURODIAB Study Group. (2009). Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–20: A multicentre prospective registration study. The Lancet, 373(9680), 2027–2033.

    Article  Google Scholar 

  • Rewers, M. J., Pillay, K., De Beaufort, C., Craig, M. E., Hanas, R., Acerini, C. L., & Maahs, D. M. (2014). Assessment and monitoring of glycemic control in children and adolescents with diabetes. Pediatric Diabetes, 15, 102–114.

    Article  Google Scholar 

  • Rhodes, E. T., Prosser, L. A., Hoerger, T. J., Lieu, T., Ludwig, D. S., & Laffel, L. M. (2012). Estimated morbidity and mortality in adolescents and young adults diagnosed with type 2 diabetes mellitus. Diabetic Medicine, 29(4), 453–463.

    Article  Google Scholar 

  • Shaw, J. (2007). Epidemiology of childhood type 2 diabetes and obesity. Pediatric Diabetes, 8(s9), 7–15.

    Article  Google Scholar 

  • Shulman, R., Miller, F. A., Stukel, T. A., Daneman, D., & Guttmann, A. (2017). Pediatric insulin pump therapy: Reflecting on the first 10 years of a universal funding program in Ontario. Healthcare Quarterly (Toronto, Ont.), 19(4), 6.

    Article  Google Scholar 

  • Songini, M., Mannu, C., Targhetta, C., & Bruno, G. (2017). Type 1 diabetes in Sardinia: Facts and hypotheses in the context of worldwide epidemiological data. Acta Diabetologica, 54(1), 9–17.

    Article  Google Scholar 

  • TODAY Study Group. (2012). A clinical trial to maintain glycemic control in youth with type 2 diabetes. The New England Journal of Medicine, 2012(366), 2247-2256.

    Article  Google Scholar 

  • Triggs-Raine, B. L., Kirkpatrick, R. D., Kelly, S. L., Norquay, L. D., Cattini, P. A., Yamagata, K., … Hegele, R. A. (2002). HNF-1α G319S, a transactivation-deficient mutant, is associated with altered dynamics of diabetes onset in an Oji-Cree community. Proceedings of the National Academy of Sciences, 99(7), 4614-4619.

    Article  Google Scholar 

  • Usher-Smith, J. A., Thompson, M., Ercole, A., & Walter, F. M. (2012). Variation between countries in the frequency of diabetic ketoacidosis at first presentation of type 1 diabetes in children: A systematic review. Diabetologia, 55(11), 2878-2894.

    Article  Google Scholar 

  • Zeitler, P., Fu, J., Tandon, N., Nadeau, K., Urakami, T., Barrett, T., & Maas, D. (2014). International Society for Paediatric and Adolescent Diabetes ISPAD clinical practice consensus guidelines 2014. Type 2 diabetes in the child and adolescent. Paediatr Diabetes, 15(Suppl 20), 26–146.

    Google Scholar 

  • Zdravkovic, V., Daneman, D., & Hamilton, J. (2004). Presentation and course of type 2 diabetes in youth in a large multi-ethnic city. Diabetic Medicine, 21(10), 1144–1148.

    Article  Google Scholar 

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Correspondence to Denis Daneman .

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Daneman, D. (2020). Update on Medical Management of Diabetes in Children and Adolescents: Epidemiology and Treatment. In: Delamater, A., Marrero, D. (eds) Behavioral Diabetes. Springer, Cham. https://doi.org/10.1007/978-3-030-33286-0_2

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