Diabetes mellitus in children

Diabetes mellitus in children is a group of metabolic diseases characterized by hyperglycemia, which is the result of impaired insulin secretion, insulin action, or both (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 mellitus in children varies significantly in different countries of the world. The highest incidence is in the Scandinavian countries (Finland, Sweden, Denmark, Norway). Seasonal fluctuations in the incidence of the disease have been recorded. The highest incidence of type 1 diabetes mellitus occurs in the winter months, which coincides with the maximum incidence of viral infectious diseases. There are two age peaks of incidence - 10-12 years and 5-7 years. In recent years, especially in countries with increased incidence, a tendency towards a higher incidence of the disease in children at an early age (0-5 years) has been noted.

[ 1 ], [ 2 ], [ 3 ], [ 4 ]

Causes of Diabetes in Children

It is assumed that both genetic predisposition and environmental factors play a role in the development of this process. 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 links in the body's autoimmune processes. More than 95% of patients with type 1 diabetes have the HLA-DR3, -DR4 or -DR3/DR4 alleles. A high degree of predisposition to type 1 diabetes is carried by combinations of certain allelic variants of the HLA-DQh DR genes.

What causes diabetes?

Symptoms of Diabetes in Children

The pre-manifest stages of diabetes mellitus type 1 have no specific clinical symptoms. Clinical manifestation develops after the death of 80-90% of beta cells and is characterized by the appearance of the so-called "major" symptoms - thirst, polyuria and weight loss. Moreover, at the onset of the disease, weight loss is noted, despite increased appetite and increased nutrition. The first manifestation of polyuria may be nocturnal or daytime enuresis. Growing dehydration causes dry skin and mucous membranes.

Symptoms of diabetes

Type 2 diabetes in children and adolescents

Until recently, type 2 diabetes was considered to be a disease of the adult population. Today, there are numerous publications indicating a several-fold increase in the incidence of the disease in childhood and adolescence. This is associated with factors such as obesity, physical inactivity, and heredity. In this case, hyperglycemia above 7 mmol/l on an empty stomach or postprandial hyperglycemia is observed. The presence of chronic hyperglycemia is confirmed by a high (above 6.1%) level of glycosylated hemoglobin.

A rare subtype of type 2 diabetes mellitus in children - MODY (maturity onset diabetes of youth) - is a disease with an autosomal dominant type of inheritance and genetic defects in insulin secretion or insulin receptor sensitivity. MODY is characterized by the following signs: onset before age 21, the presence of relatives with type 2 diabetes mellitus in three generations, normalization of basal hyperglycemia without insulin for at least 2 years, the absence of autoantibodies to beta-cell antigens.

[ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ]

Classification (WHO, 1999)

• Diabetes mellitus type 1:
  • autoimmune;
  • idiopathic.
• Diabetes mellitus type 2.
• Other types of diabetes:
  • genetic defects in beta cell function;
  • genetic defects in insulin action;
  • diseases of the exocrine pancreas;
  • endocrinopathies;
  • drug- or chemical-induced diabetes;
  • infectious diseases;
  • unusual forms of immune-mediated diabetes;
  • other genetic syndromes associated with diabetes mellitus.
• Gestational diabetes mellitus.

[ 12 ], [ 13 ], [ 14 ], [ 15 ], [ 16 ]

Type 1 diabetes mellitus

In childhood, diabetes mellitus type 1 is predominantly 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 susceptible individuals.

[ 17 ], [ 18 ], [ 19 ]

Complications of diabetes in children

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

Complications of diabetes

[ 20 ], [ 21 ], [ 22 ], [ 23 ]

Diagnosis of diabetes in children

Almost all children with newly diagnosed disease have some clinical symptoms. Hyperglycemia and glucosuria confirm the diagnosis of diabetes mellitus. The glucose level in venous blood plasma above 11.1 mmol/l is diagnostically significant. In addition, ketonuria is noted in most children when the diagnosis is established. Sometimes a child is found to have 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 mellitus is beyond doubt and does not require additional studies. A convincing criterion for confirming the diagnosis of type 1 diabetes mellitus is autoantibodies to islet cells (IA) and to the islet cell protein - glutamate decarboxylase in the blood serum.

Diagnosis of diabetes mellitus

[ 24 ], [ 25 ], [ 26 ], [ 27 ], [ 28 ]

Treatment of diabetes in children

The main task is to achieve and maintain stable compensation of the disease, and this is only possible with the use of a set of measures:

• diet;
• insulin therapy;
• patient education and self-monitoring;
• measured physical activity;
• prevention and treatment of late complications.

Treatment of diabetes mellitus

Prognosis of diabetes in children

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