Type 1 diabetes in childhood

Abstract

<h2>Abstract</h2> Type 1 diabetes mellitus is the most common chronic metabolic condition in children and adolescents. Its incidence is increasing worldwide. It must increasingly be differentiated from type 2 diabetes which is also increasing in prevalence in parallel with the global rise in childhood obesity. Type 1 diabetes presents initially with ketoacidosis (DKA) in 15–67% of cases. Children presenting without DKA can safely be treated on an ambulatory basis. Glycemic and HbA1c targets should be tailored to the child's age and stage of development, with higher targets in young children due to the risk of cognitive impairment secondary to repeated severe hypoglycemia. However with increasing age glycemic targets should be more rigorous given the proven benefit of tight metabolic control on the onset and progression of microvascular complications. Insulin regimens used in children range from basal-bolus approaches to continuous subcutaneous insulin infusion (CSII). CSII offers children and their families an improvement in lifestyle and metabolic control. Self-monitoring of blood glucose (SMBG) is an essential component of management, as is attention to nutritional planning. Care of the child and adolescent with type 1 diabetes should be multidisciplinary and involve professionals experienced in childhood diabetes including a physician, nurse, dietitian and social worker or psychologist. Maintenance of excellent glycemic control and regular screening for complications should be emphasized, all in the context of a healthy and supportive physical and psychosocial environment.