Type 1 diabetes mellitus was thought to be the prevalent type of diabetes in children and adolescents; however, increasing numbers of juvenile patients appear to have type 2 diabetes. Management of all diabetes in young patients should include regular assessment, careful monitoring for glycemic control and the presence of hypoglycemia, and educational training on disease management. Hypoglycemic episodes, especially nocturnal events, are frequent in the young diabetic patient. Improvements in glycemic control and nocturnal hypoglycemia have been observed with continuous subcutaneous insulin infusion and insulin glargine. A continuous glucose-monitoring system can provide important insight into 24-hour glycemic control. Overall, careful management, monitoring, and education can improve glycemic control and yield positive treatment outcomes in the child or adolescent with diabetes.
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References
1.
Silink M. Childhood diabetes: a global perspective. Horm Res. 2002;57(suppl 1):1-5.
2.
Amiel SA, Sherwin RS, Simonson DC, et al.Impaired insulin action in puberty. A contributing factor to poor glycemic control in adolescents with diabetes. N Engl J Med. 1986;315:215-219.
3.
Rowell HA, Evans BJ, Quarry-Horn JL, Kerrigan JR. Type 2 diabetes mellitus in adolescents. Adolesc Med. 2002;13:1-12.
4.
Nesmith JD. Type 2 diabetes mellitus in children and adolescents. Pediatr Rev. 2001;22:147-152.
5.
Fagot-Campagna A, Pettitt DJ, Engelgau MM, et al.Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J Pediatr. 2000;136:664-672.
6.
Rosenbloom AL, Joe JR, Young RS, Winter WE. Emerging epidemic of type 2 diabetes in youth. Diabetes Care. 1999;22:345-354.
7.
Pickup JC, Keen H, Parsons JA, Alberti KG. Continuous subcutaneous insulin infusion: an approach to achieving normoglycaemia. BMJ. 1978;1:204-207.
8.
Tamborlane WV, Sherwin RS, Genel M, Felig P. Reduction to normal of plasma glucose in juvenile diabetes by subcutaneous administration of insulin with a portable infusion pump. N Engl J Med. 1979;300:573-578.
9.
Boland EA, Grey M, Oesterle A, et al.Continuous subcutaneous insulin infusion. A new way to lower risk of severe hypoglycemia, improve metabolic control, and enhance coping in adolescents with type 1 diabetes. Diabetes Care. 1999;22:1779-1784.
10.
Kaufman FR, Halvorson M, Miller D, et al.Insulin pump therapy in type 1 pediatric patients: now and into the year 2000. Diabetes Metab Res Rev. 1999;15:338-352.
11.
Diabetes Control and Complications Trial Research Group. Resource utilization and costs of care in the diabetes control and complications trial. Diabetes Care. 1995;18:1468-1478.
12.
Tamborlane WV, Bonfig W, Boland E. Recent advances in treatment of youth with Type 1 diabetes: better care through technology. Diabet Med. 2001;18:864-870.
13.
The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977-986.
14.
Tanenberg RJ. Candidate selection. In: Fredrickson L, ed. The Insulin Pump Therapy Book: Insights from the Experts. 1995 ed.Sylmar, CA: MiniMed; 1995:20-31.
15.
Ahern JA, Boland EA, Doane R, et al.Insulin pump therapy in pediatrics: a therapeutic alternative to safely lower HbA1c levels across all age groups. Pediatr Diabetes. 2002;3:10-15.
16.
Weinzimer SA, Ahern JH, Boland EA, et al.Persistence of benefits of continuous subcutaneous insulin infusion (CSU) in infants and toddlers. Pediatrics. 2004;114:1601-1605.
17.
Kaufman FR, Halvorson M, Kim C, Pitukcheewanont P. Use of insulin pump therapy at nighttime only for children 7-10 years of age with type 1 diabetes. Diabetes Care. 2000;23:579-582.
18.
Amiel SA, Caprio S, Sherwin RS, et al.Insulin resistance of puberty: a defect restricted to peripheral glucose metabolism. J Clin Endocrinol Metab. 1991;72:277-282.
19.
Lepore M, Pampanelli S, Fanelli C, et al.Pharmacokinetics and pharmacodynamics of subcutaneous injection of long-acting human insulin analog glargine, NPH insulin, and ultralente human insulin and continuous subcutaneous infusion of insulin lispro. Diabetes. 2000;49:2142-2148.
20.
Holcombe JH, Zalani S, Arora VK, Mast CJ. Comparison of insulin lispro with regular human insulin for the treatment of type 1 diabetes in adolescents. Clin Ther. 2002;24:629-638.
21.
Mortensen HB, Lindholm A, Olsen BS, Hylleberg B. Rapid appearance and onset of action of insulin aspart in paediatric subjects with type 1 diabetes. Eur J Pediatr. 2000;159:483-488.
Schober E, Schoenle E, Van Dyk J, Wernicke-Panten K, the Pediatric Study Group of Insulin Glargine. Comparative trial between insulin glargine and NPH insulin in children and adolescents with type 1 diabetes. Diabetes Care. 2001;24:2005-2006.
24.
Kordonouri O, Deiss D, Hopfenmueller W, et al.Treatment with insulin glargine (Lantus®) reduces asymptomatic nightly hypoglycemia detected by continuous subcutaneous glucose monitoring (CGMS) in children and adolescents with type 1 diabetes (dm) [abstract]. Diabetes. 2002;51(suppl 2):A427.
25.
Dunger DB, Edge JA, Skvor J. Insulin glargine provides long-term effective glycemic control in children and ado lescents with type 1 diabetes. Diabetes. 2002;51(suppl 2):A426.
26.
Murphy NP, Keane SM, Ong KK, et al.A randomized cross-over trial comparing insulin glargine plus lispro with NPH insulin plus soluble insulin in adolescents with type 1 diabetes. Diabetes. 2002;51(suppl 2):A54.
27.
Pearson J, Chase HP, Wightman C, et al.Reduction of severe hypoglycemic episodes in children and adolescents with type 1 diabetes using insulin-glargine therapy. Diabetes. 2002;51 (suppl 2):A425.
28.
UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk Of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837-853.
29.
American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care. 2000;23:381-389.
30.
Libman I, Arslanian SA. Type II diabetes mellitus: no longer just adults. Pediatr Ann. 1999;28:589-593.
31.
Arslanian S. Type 2 diabetes in children: clinical aspects and risk factors. Horm Res. 2002;57(suppl 1):19-28.
32.
Arslanian SA. Type 2 diabetes mellitus in children: pathophysiology and risk factors. J Pediatr Endocrinol Metab. 2000;13(suppl 6):1385-1394.
33.
Roth J. Widening awareness of hyperglycemia unawareness. Diabetes Metab Res Rev. 2000;16:228-229.
34.
Harris MI, Eastman RC. Early detection of undiagnosed diabetes mellitus: a US perspective. Diabetes Metab Res Rev. 2000;16:230-236.
35.
Harris MI. Undiagnosed NIDDM: clinical and public health issues. Diabetes Care. 1993;16:642-652.
36.
Troiano RP, Flegal KM, Kuczmarski RJ, et al.Overweight prevalence and trends for children and adolescents. The National Health and Nutrition Examination Surveys, 1963 to 1991. Arch Pediatr Adolesc Med. 1995;149:1085-1091.
37.
Sinha R, Fisch G, Teague B, et al.Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med. 2002;346:802-810.
38.
Jones KL. Treatment of type 2 diabetes mellitus in children. JAMA. 2002;287:716.
39.
Jones KL, Arslanian S, Peterokova VA, et al.Effect of metformin in pediatric patients with type 2 diabetes: a randomized controlled trial. Diabetes Care. 2002;25:89-94.
40.
Boland EA, Tamborlane WV. Continuous glucose monitoring in youth with type 2 diabetes: overcoming barriers to successful treatment. Diabetes Technol Ther. 2000;2(suppl 1):S53-S59.
41.
Bhatia V, Wolfsdorf JI. Severe hypoglycernia in youth with insulin-dependent diabetes mellitus: frequency and causative factors. Pediatrics. 1991;88:1187-1193.
42.
Boland E, Monsod T, Delucia M, et al.Limitations of conventional methods of self-monitoring of blood glucose: lessons learned from 3 days of continuous glucose sensing in pediatric patients with type 1 diabetes. Diabetes Care. 2001;24:1858-1862.
43.
Kaufman FR, Gibson LC, Halvorson M, et al.A pilot study of the continuous glucose monitoring system: clinical decisions and glycemic control after its use in pediatric type 1 diabetic subjects. Diabetes Care. 2001;24:2030-2034.
44.
Kaufman FR. Role of the continuous glucose monitoring system in pediatric patients. Diabetes Technol Ther. 2000;2(suppl 1):S49-S52.
45.
Chase HP, Kim LM, Owen SL, et al.Continuous subcutaneous glucose monitoring in children with type 1 diabetes. Pediatrics. 2001;107:222-226.
46.
The accuracy of the GlucoWatch® G2™ biographer in children with type 1 diabetes: results of the diabetes research in children network (Direc-Net) accuracy study. Diabetes Technol Ther. 2003;5:791-800.
47.
The accuracy of the CGMS™ in children with type 1 diabetes: results of the diabetes research in children network (DirecNet) accuracy study. Diabetes Technol Ther. 2003;5:781-789.
48.
A multicenter study of the accuracy of the One Touch® Ultra® home glucose meter in children with type 1 diabetes. Diabetes Technol Ther. 2003;5:933-941.
49.
The Diabetes Research in Children Network (DirecNet) Study Group. Accuracy of the GlucoWatch G2 Biographer and the continuous glucose monitoring system during hypoglycemia: experience of the Diabetes Research in Children Network. Diabetes Care. 2004;27:722-726.
50.
Hanson CL, Cigrang JA, Harris MA, et al.Coping styles in youths with insulin-dependent diabetes mellitus. J Consult Clin Psychol. 1989;57:644-651.
51.
Grey M, Boland EA, Davidson M, et al.Coping skills training for youth with diabetes mellitus has long-lasting effects on metabolic control and quality of life. J Pediatr. 2000;137:107-113.
