Diabetes in Childhood

 

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Diabetes is one of the most common chronic diseases of childhood

  • In the EU, more than 88,000 children have diabetes

  • This number is growing by 3% to 5% every year      

  • Over 90% of children with diabetes have type 1 diabetes

  • The life expectancy of children with diabetes is reduced by up to 15 years

 

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About Diabetes

Diabetes is a serious progressive chronic condition occurring as a result of problems in the production and supply of insulin. Insulin is the hormone responsible for helping tissues to use glucose (sugar), the body’s energy source. There are two major types of diabetes:

Type 1 diabetes (T1DM) is an autoimmune disease caused by the destruction of insulin-producing cells by the body’s own immune system. It is a life-long disease that occurs when the pancreas stops producing insulin and blood sugar levels arise as a result. Type 1 diabetes typically occurs before the age of 30.There is no conclusive evidence thus far that it can be prevented.

Patients with type 1 diabetes need daily insulin treatment to survive, delivered via multiple injections with syringes or insulin pens or via an insulin pump, allowing continuous infusion of insulin and adding extra dosage as needed.

In addition, blood glucose levels have to be measured on a regular basis throughout the day to control and if needed improve the management of their diabetes. The most common ways to monitor blood sugar levels are:

  • Self-monitoring with finger-sticks meter reading at least before and after meals as well as at bedtime.
     
  • Continuous glucose monitoring (CGM) with a sensor placed onto the patient’s abdomen providing continuously sugar levels readings.
     
  • HbA1c measurement: a blood sugar test performed by a healthcare professional, which indicates the average blood sugar levels over 2-3 months.

Poor blood sugar level control can lead to:

  • hyperglycaemia (high blood glucose levels): Without an adequate supply of insulin a person with diabetes is unable to keep glucose levels in balance, creating a situation of hyperglycaemia. Untreated, severe hyperglycaemia can result in coma (diabetic ketoacidosis, DKA) and death due to the accumulation of organic acids and ketones in the blood. DKA is still a leading cause of morbidity and mortality in children with type 1 diabetes.  Blood glucose levels which are chronically higher than normal values can also lead to long-term complications such as cardiovascular disease, blindness and renal failure.
     
  • hypoglycaemia (low blood glucose levels): Administration of too much insulin can lead to severe hypoglycaemia which can result in loss of consciousness, seizures and eventually coma or death if unmanaged.

Type 2 diabetes (T2DM) is a polymorphic chronic disease characterised by a dysfunction in insulin secretion or by a missing effectiveness of the produced insulin. The disease develops when the body can still produce some insulin, but not enough, or when there is a resistance to the insulin produced.

Type 2 diabetes is often linked to obesity and physical inactivity and can be prevented and treated with lifestyle changes such as healthier diet (diet low on carbohydrates and with a low glycaemic index) and increased physical exercise. The main aim of type 2 diabetes treatment is a normalisation of the blood glucose levels in order to avoid/reduce comorbidities and long-term complications. At a later stage, treatment can involve tablets and/or insulin.

In Europe, 5% of children and adolescents with diabetes currently have type 2 diabetes. This number is increasing due to the obesity epidemic which also affects the younger generations.

In addition, 17 % from the obese adolescent population is affected by an eating disorder and 70% suffers from anxiety or depression. There are however sufficient intervention programmes for children and their families (including lifestyle changes such as healthier diet and increased physical exercise) supporting as such the primary prevention of type 2 diabetes in children and adolescents.