Diabetes is one of the most common chronic conditions in school-age children in the United States. About 208,000 youth under 20 years old have diabetes, 0.25 percent of all in this age group. 1 Type 1 diabetes accounts for nearly all diabetes in children under age 10. After age 10, type 1 is the most common form in U.S. youth overall, but type 2 is more common in new cases among minority groups, with the highest rates in American Indian youth. Distinction between type 1 and type 2 diabetes can be difficult but is important for determining appropriate treatment. 2 Testing for type 2 diabetes should be considered in overweight or obese youth with additional risk factors, such as family history, race or ethnicity, acanthosis nigricans, or polycystic ovary syndrome.
Most newly diagnosed cases of type 1 diabetes occur in individuals younger than 18. More children and teens are now getting type 2 diabetes, and the incidence of both type 1 and type 2 diabetes in youth is increasing. Therefore, the unique requirements for this age group must be addressed. Care of this group requires integration of diabetes management with the complicated physical and emotional growth needs of children, adolescents, and their families, as well as consideration of teens’ emerging autonomy and independence. Diabetes care for children and teens should be provided by a team that can deal with these special medical, educational, nutritional, and behavioral issues. The team usually consists of a physician, diabetes educator, dietitian, social worker or psychologist, and school nurse, along with the patient and family. Children should be seen by members of the team at diagnosis and follow-up, as determined by the primary care provider, the patient and family, and the team. Planning for transition of care from parents to self and from pediatric endocrinologists to adult care providers is essential during the vulnerable time as teens transition into adulthood.
Youth with diabetes need self-management support. This involves close communication and cooperation between the diabetes care team, school nurses, and other school personnel for optimal management, safety, and academic opportunities. The team, in partnership with the young person with diabetes and parents or other caregivers, needs to develop a personal diabetes management plan and daily schedule. The plan helps the child or teen follow a healthy meal plan, get regular physical activity (ideally, 60 minutes each day), check blood glucose levels, take insulin or oral medication as prescribed, and manage hyperglycemia and hypoglycemia. In children with type 1 diabetes, the most common problem encountered during physical activity is hypoglycemia. If possible, children and teens should check blood glucose levels before beginning a game or a sport and learn to prevent hypoglycemia. Family support for following the meal plan and setting up regular meal times is a key to success, especially if the child or teen is taking insulin.
Diabetes is stressful for both children and their families. Parents should be alert for signs of depression or eating disorders or insulin omission to lose weight and should seek appropriate treatment. Depression is a common comorbidity, affecting youth with both type 1 and type 2 diabetes, and should be assessed at each visit. Mental health specialists with expertise in diabetes can support the health care team, assess young people with diabetes for depression and other psychosocial problems, and provide ongoing contact and support.
Camps and local peer groups for children and teens with diabetes can provide positive role models and group activities. Peer encouragement often helps children perform diabetes-related tasks that they had been afraid to do previously and encourages independence in diabetes management. Talking with other children who have diabetes helps young people feel less isolated and less alone in having to deal with the demands of diabetes. Online chat rooms, such as Glu, have been successful in building diabetes communities for children and adolescents.
Glycemic control is particularly challenging for adolescents. In selecting glycemic goals for youth with diabetes, health care teams should balance the long-term health outcome benefits of achieving a lower A1C against the risks of hypoglycemia and the burdens of intensive regimens in children and adolescents. Because the benefit of glycemic control may persist for decades with reduced rates of microvascular complications, it is important to provide access to and education about evolving technologies that support the management of type 1 diabetes. This includes advances in insulin pump and continuous subcutaneous glucose monitoring technologies.
Youth with diabetes in the United States carry a substantial burden of cardiovascular disease (CVD) risk factors, especially youth who are overweight or obese. Fourteen percent of youth with type 1 diabetes and 92 percent of youth with type 2 diabetes have more than two CVD risk factors. 3 Overweight and obesity in children are strongly correlated with insulin resistance and associated hypertension and dyslipidemia, conditions that require intensive efforts to improve dietary intake and activity and to normalize body weight as a first-line approach. Pharmacologic treatment of hypertension should be initiated if blood pressure consistently exceeds the 95th percentile for age, sex, and height. Statin therapy is recommended as the preferred agent for treatment of dyslipidemia in children, but it is not approved for use in children less than 8 years old.
For children and teens at risk for type 2 diabetes, the health care team can encourage, support, and educate the entire family to make lifestyle changes that may delay or lower the risk for the onset of type 2 diabetes. Such lifestyle changes include keeping at a healthy weight and staying active.
Resources for care of children and adolescents