Diabetes mellitus in children

Diabetes mellitus in children is a group of metabolic (metabolic) diseases characterized by hyperglycemia, which is the result of impaired insulin secretion, insulin action, or both of these factors (WHO, 1999).

ICD-10 code

• E10 Insulin-dependent diabetes mellitus.
• E11 Non-insulin dependent diabetes mellitus.

Synonyms

Insulin-dependent diabetes mellitus.

Epidemiology

The incidence of type 1 diabetes in children varies greatly from country to country. The highest frequency is in the Scandinavian countries (Finland, Sweden, Denmark, Norway). Seasonal variations in the incidence of the disease were recorded. The greatest frequency of manifestation of type 1 diabetes mellitus occurs in the winter months, which coincides with the maximum incidence of viral infectious diseases. There are two age-specific peak incidence - 10-12 years and 5-7 years. In recent years, especially in countries with increased morbidity, there has been a trend towards a higher incidence of disease in children at an early age (0-5 years).

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13]

Causes of diabetes in children

It is assumed that in the development of this process both the genetic predisposition and the factors of the external environment matter. Hereditary predisposition to type 1 diabetes is associated with an unfavorable combination of normal genes located in different loci on different chromosomes, most of which control various parts of autoimmune processes in the body. More than 95% of patients with type 1 diabetes have HLA-DR3, -DR4 or -DR3 / DR4 alleles. A high degree of predisposition to type 1 diabetes mellitus is carried by combinations of certain allelic variants of HLA-DQh DR-genes.

What causes diabetes?

[14], [15]

Symptoms of diabetes in children

Dysonific stages of diabetes mellitus 1 do not have specific clinical symptoms. Clinical manifestation develops after the death of 80-90% of beta-cells and is characterized by the appearance of so-called "big" symptoms - thirst, polyuria and weight loss. And at the beginning of the disease, weight loss is noted, despite the increased appetite and increased nutrition. The first manifestation of polyuria may be night or daytime enuresis. Increasing dehydration causes dry skin and mucous membranes.

Symptoms of Diabetes

Diabetes mellitus type 2 in children and adolescents

Until recently, type 2 diabetes was considered the lot of the adult population. Today there are numerous publications that testify to an increase in the incidence of the disease in childhood and adolescence by several times. This is associated with factors such as obesity, hypodynamia and heredity. At the same time, hyperglycaemia is observed above 7 mmol / L in fasting or postprandial hyperglycemia. The presence of chronic hyperglycemia is confirmed by a high (above 6.1%) level of glycosylated hemoglobin.

A rare subtype of type 2 diabetes in children - MODY (maturity the onset of diabetes of youth) - a disease with autosomal dominant inheritance and genetic defects in insulin secretion or sensitivity of insulin receptors. For MODY, the following symptoms are characteristic: beginning before age 21, presence of relatives with type 2 diabetes in three generations, normalization of basal hyperglycaemia without insulin for at least 2 years, absence of autoantibodies to beta-cell antigens.

[16], [17], [18], [19], [20], [21], [22]

Classification (WHO, 1999)

• Type 1 diabetes mellitus:
  • autoimmune;
  • idiopathic.
• Type 2 diabetes mellitus.
• Other types of diabetes mellitus:
  • genetic defects of beta-cell function;
  • genetic defects in the action of insulin;
  • disease exocrine parts of the pancreas;
  • endocrinopathy;
  • diabetes induced by drugs or chemicals;
  • infectious diseases;
  • unusual forms of immune-mediated diabetes;
  • other genetic syndromes, combined with diabetes.
• Gestational diabetes mellitus.

[23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33]

Diabetes mellitus type 1

In childhood, mainly type 1 diabetes mellitus is observed. It is characterized by an absolute insulin deficiency caused by an autoimmune process that leads to progressive selective damage to the beta cells of the pancreas in predisposed individuals.

[34], [35], [36], [37], [38], [39], [40]

Complications of diabetes in children

Diabetic angiopathies - the main cause of disability in patients with diabetes mellitus 1 - develop in chronic hyperglycemia and have common morphological features: aneurysmal changes in capillaries, thickening of the arterioles, capillaries and venules wall due to the accumulation in the basal membrane of glycoproteins and neutral mucopolysaccharides, proliferation of the endothelium and its desquamation into the lumen vessels, leading to their obliteration.

Complications of diabetes mellitus

[41], [42], [43], [44], [45], [46]

Diagnosis of diabetes mellitus in children

Practically all children with a newly diagnosed disease have certain clinical symptoms. Hyperglycemia and glucosuria confirm the diagnosis of diabetes mellitus. The level of glucose in plasma of venous blood is higher than 11.1 mmol / l. In addition, most children diagnosed with ketonuria. Sometimes a child shows an increase in glucose concentration above 8 mmol / l in the absence of symptoms of the disease. If the postprandial glucose level (two hours after eating) is repeatedly higher than 11.0 mmol / l, the diagnosis of diabetes is unquestionable and does not require additional research. A convincing criterion for confirming the diagnosis of type 1 diabetes mellitus is the autoantibody to islet cells (1CA) and to the islet cell protein-glutamate decarboxylase in the blood serum.

Diagnosis of diabetes mellitus

[47], [48], [49], [50], [51], [52], [53], [54], [55], [56]

Treatment of diabetes in children

The main task is to achieve and maintain a sustainable compensation of the disease, and this is possible only when using a set of measures:

• diet;
• insulin therapy;
• patient education and self-control;
• dosed physical exercise;
• prevention and treatment of late complications.

Treatment of diabetes mellitus

Prognosis of diabetes in children

Currently, the treatment of a patient with type 1 diabetes is impossible. The prognosis for life and ability to work depends on the degree and duration of compensation for impaired carbohydrate metabolism. Achieving and maintaining an HbAlc score of less than 7.6% determines the prevention of complications, therefore, a favorable prognosis for life and ability to work.