Update on medical management of diabetes in children and adolescents: Epidemiology and treatment

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.