Overview of type 1 diabetes in children and adolescents
Type 1 diabetes is a condition of insulin deficiency. It is most commonly caused by immune-mediated destruction of the insulin-producing pancreatic beta cells, but also includes cases where the aetiology of beta-cell destruction is unknown. The rate of beta-cell destruction is variable; the rate is often more rapid in infants and children compared with adults. Although the incidence peaks in adolescence and early adulthood, type 1 diabetes may occur at any age. Diabetes in children and adolescents is predominantly type 1.
A presentation of hyperglycaemia with or without symptoms of diabetes (eg polyuria, polydipsia, weight loss) in a child or adolescent is a medical emergency. Immediate specialist assessment and management are required to avoid development of life-threatening complications of acute insulin deficiency, such as diabetic ketoacidosis (DKA). Refer the patient to the local emergency department, or phone the nearest children’s hospital or major healthcare service for specialist endocrinology advice.
Children and adolescents should be presumed to have, and be treated for, type 1 diabetes unless proven otherwise by specialist assessment.
Children with type 1 diabetes should be diagnosed and managed by a multidisciplinary diabetes team. The recommendations in this topic are based on international evidence-based clinical practice guidelines for type 1 diabetes in children and adolescents1.
General management principles for type 1 diabetes are discussed in Principles of management of diabetes but some adjustments are required for children. Avoiding both severe hypoglycaemia and chronic hyperglycaemia is particularly important in infants and toddlers, because these are stages of rapid brain growth.
Additional considerations when managing children with type 1 diabetes include:
- the need to monitor growth and pubertal development
- their often erratic and unpredictable eating and activity patterns (particularly preschool-age children)
- awareness of age-specific behaviours
- awareness of family interactions.
Adolescence may be a particularly demanding time for young patients and their families or carers. Regular attendance at age-specific multidisciplinary diabetes clinics is important for expert management, including mental health support for the patient and their family or carers, as required. For information about transition from child-centred to adult-centred diabetes care, see Transition of adolescents to adult diabetes management.
Practical information for parents and carers of children and adolescents with type 1 diabetes is given in the parent’s manual Caring for diabetes in children and adolescents2.
Screening for type 1 diabetes in family members of patients with type 1 diabetes is not recommended routinely; however, there are research programs in Australia that enrol asymptomatic first-degree relatives of patients with type 1 diabetes in natural history and intervention studies (eg Type1Screen program). Further information can be found through the patient's specialist. At the time of writing, there is no treatment to prevent the development of type 1 diabetes.