Type 1 Diabetes

Type 1 diabetes accounts for 5 to 10 percent of all diagnosed cases of diabetes, but is the leading cause of diabetes in children of all ages. Type 1 diabetes accounts for almost all diabetes in children less than 10 years of age. Type 1 diabetes is an autoimmune disease in which the immune system destroys the insulin-producing beta cells of the pancreas that help regulate blood glucose levels. Onset. Type 1 diabetes mostly has an acute onset, with children and adolescents usually able to pinpoint when symptoms began. Onset can occur at any age, but it most often occurs in children and young adults. Children and adolescents may present with ketoacidosis as the first indication of type 1 diabetes. Others may have post-meal hyperglycemia, or modest fasting hyperglycemia that rapidly progresses to severe hyperglycemia and/or ketoacidosis in the presence of infection or other stress.

Symptoms. The immunologic process that leads to type 1 diabetes can begin years before the symptoms of type 1 diabetes develop. Symptoms become apparent when most of the beta-cell population is destroyed and usually develop over a short period of time. Early symptoms, which are mainly due to hyperglycemia, include increased thirst and urination, constant hunger, weight loss, and blurred vision. Children also may feel very tired. The immunologic process that leads to type 1 diabetes can begin years before the symptoms of type 1 diabetes develop. Symptoms become apparent when most of the beta-cell population is destroyed and usually develop over a short period of time. Early symptoms, which are mainly due to hyperglycemia, include increased thirst and urination, constant hunger, weight loss, and blurred vision. Children also may feel very tired.

Risk Factors. A combination of genetic and environmental factors put people at increased risk for type 1 diabetes. Researchers are working to identify these factors so that targeted treatments can be designed to stop the autoimmune process that destroys the pancreatic beta-cells.

Co-morbidities. Children with type 1 diabetes are at risk for the long-term complications of diabetes. Autoimmune diseases such as celiac disease and autoimmune thyroiditis are also associated with type 1 diabetes.

Management. The basic elements of type 1 diabetes management are insulin administration (either by injection or insulin pump), nutrition management, physical activity, blood glucose testing, the avoidance of severe hypoglycemia, and the avoidance of prolonged hyperglycemia or DKA. Algorithms are used for insulin dosing based on blood glucose level and food intake.

Diabetes in Children and Adolescents

Overview of Diabetes in Children and Adolescents

Diabetes mellitus is a group of diseases characterized by high levels of glucose in the blood resulting from defects in insulin production, insulin action, or both. Diabetes is associated with serious complications and premature death, but timely diagnosis and treatment of diabetes can prevent or delay the onset of long-term complications (damage to the cardiovascular system, kidneys, eyes, nerves, blood vessels, skin, gums, and teeth). New management strategies are helping children with diabetes live long and healthy lives. Type 1 diabetes in U.S. children and adolescents is increasing (1) and more new cases of type 2 diabetes are being reported in young people. The American Diabetes Association provides helpful guidance in consensus statements for managing children with type 1 diabetes (2) and type 2 diabetes (3). To update primary care providers and their staff about this evolving area of diabetes care, the NDEP has developed this overview of current statistics and care recommendations.

Statistics

Diabetes is one of the most common diseases in school-aged children. According to the 2011 National Diabetes Fact Sheet, about 215,000 young people in the US under age 20 had diabetes in 2010. This represents 0.26 percent of all people in this age group. (4) Based on data from 2002 to 2005, the SEARCH for Diabetes in Youth study reported that approximately 15,600 US youth less than 20 years of age were diagnosed annually with type 1 diabetes, while 3,600 were newly diagnosed with type 2 diabetes. (5) Type 2 diabetes was rare in children younger than 10 years of age, regardless of race or ethnicity. In youth aged 10 to 19 years, type 2 diabetes became increasingly common, especially in minority populations such as American Indians, African Americans, Hispanic/Latinos, Asians and Pacific Islanders. Among non-Hispanic white youth aged 10 to19 years, the rate of new cases was higher for type 1 than for type 2 diabetes. For Asian/Pacific Islander and American Indian youth aged 10–19 years, the opposite was true—the rate of new cases was greater for type 2 than for type 1 diabetes. Among non-Hispanic black and Hispanic youth aged 10 to19 years, the rates of new cases of type 1 and type 2 diabetes were similar. (5)