pediatrics
Diabetes Mellitus in Children and Adolescents
Key Points
Type 1 diabetes is caused by an autoimmune attack on pancreatic beta-cells, causing complete lack ofinsulin; it accounts for two thirds of new cases in children and can occur at any age. Type 2 diabetes is caused byinsulinresistance and relativeinsulindeficiency due to a complex interaction among many genetic and environmental factors (particularly obesity); it is increasing in frequency in children and occurs after puberty. Most children have symptomatic hyperglycemia without acidosis, with several days to weeks of urinary frequency, polydipsia, and polyuria; children with type 1 diabetes and rarely type 2 diabetes may present with diabetic ketoacidosis. Screen asymptomatic, at-risk children for type 2 diabetes or prediabetes. All children with type 1 diabetes requireinsulintreatment; intensive glycemic control helps prevent long-term complications but increases risk of hypoglycemic episodes. Advances in diabetes technology, such as continuous glucose monitoring systems, are aimed at improving glycemic control while reducing hypoglycemic episodes. Children with type 2 diabetes are initially treated withmetforminand/orinsulin; although most children requiringinsulinat diagnosis can be successfully transitioned tometforminmonotherapy, about half eventually requireinsulintreatment. Liraglutidecan be used in combination withmetforminto improve glycemic control. Mental health issues are common among children with diabetes and can be associated with poor glycemic control. Insulindoses are adjusted based on frequent glucose monitoring and anticipated carbohydrate intake and activity levels. Children are at risk of microvascular and macrovascular complications of diabetes, which must be sought by regular screening tests. 