Diabetes in Children and Adolescents
Symptoms and Management

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Copyright © 2021 Wild Iris Medical Education, Inc. All Rights Reserved.

BY: 

Maryam K. Mamou, BSN, RN, CWCN, CRRN

LEARNING OUTCOME AND OBJECTIVES:  Upon completion of this continuing education course, you will have increased your understanding of the impact of diabetes on children and adolescents. Specific learning objectives to address potential knowledge gaps include:

  • Review the prevalence of type 1 and type 2 diabetes in children and adolescents.
  • Describe the diagnosis of diabetes in children and adolescents.
  • Summarize diabetes treatment and management strategies in youth.
  • Explain the medical complications associated with diabetes in children and youth.
  • Outline the common challenges facing children with diabetes and their families.
  • Explain the issues faced by adolescents with diabetes.
  • Discuss the transition from pediatric to adult diabetes care.

TABLE OF CONTENTS

  • Introduction
  • Diagnosing Diabetes in Children and Youth
  • Diabetes Management in Children and Adolescents
  • Medical Complications Associated with Diabetes in Children
  • Challenges Facing Children with Diabetes and Their Families
  • Issues Facing Adolescents with Diabetes
  • Transition to Adult Care
  • Conclusion
  • Resources
  • References

INTRODUCTION


Clinicians in all care settings are encountering children with diabetes, and the number of children with type 1 and type 2 diabetes is increasing. Type 2 diabetes (T2D), once considered a disease of older adults, is on the rise in children of all age groups and disproportionally among racial minorities and low-income families. Research has found that children and adolescents who are obese are at the greatest risk for developing type 2 diabetes between the ages of 10 to 18 years. As of 2021, around 13.7 million children and youth in the United States are obese (Tamborlane, 2021; CDC, 2021a).

Type 1 diabetes (T1D) is one of the most frequently found conditions among children. T1D is on the increase worldwide. No one cause has been pinpointed for this increase, but some of the areas that are being researched include changes in lifestyle and environmental factors (Mobasseri et al., 2020; Tamborlane, 2021).

According to the CDC, around 1 in every 5 youths between the ages of 12–18 years also have prediabetes. (Prediabetes is a condition diagnosed when fasting glucose levels are elevated in the range of 101–125 mg/dL on more than one occasion.) Research findings show that among adolescents, the rate of prediabetes is higher in young males and those who are obese. Prediabetes places children at high risk for developing type 2 diabetes, but this can be reversed by lifestyle modifications such as decreased calorie intake and increase levels of exercise (CDC, 2020c, 2019).

While diabetes affects children of all ages, impacts of diabetes vary among different age groups. Clinicians must therefore be equipped with a wide range of knowledge in order to provide care to children and their families. For instance, parents of toddlers with diabetes may have to deal with the erratic eating habits of their children when trying to dose insulin. Parents of grade schoolers may be worried about managing diabetes in their children who want to play sports.

Likewise, coping with diabetes can present many challenges for adolescents, especially those who are newly diagnosed with the condition. Many youths find it difficult to adjust to a diagnosis of a chronic condition they see as curtailing their freedom and choices—one that sets them apart from their peers during a time when peer acceptance is essential to their well-being. The role of the clinician is also pivotal in fostering the development of positive coping skills for the adolescent patient with diabetes and for their families.

Prevalence of Diabetes among Children and Youth

According to the National Diabetes Statistics Report, around 210,000 children and youth under the age of 20 years in the United States had a diagnosis of diabetes as of 2018. Of this group, 187,000 were diagnosed with type 1 diabetes, making T1D the most prevalent form of diabetes in children and adolescents (CDC, 2020c; ADA, 2020).

During 2014–2015, the approximate yearly number of newly diagnosed cases of diabetes in the United States included:

  • 18,291 children and adolescents younger than 20 years of age with type 1 diabetes
  • 5,758 children and adolescents between the ages of 10–19 years with type 2 diabetes
    (CDC, 2020c)
SEARCH FOR DIABETES IN YOUTH STUDY

This study began in 2000. It is funded by the CDC, with support from the National Institute of Diabetes and Digestive and Kidney Diseases. The purpose of the study is to investigate the considerable knowledge gap that exists in the understanding of childhood diabetes. Five centers across the country are involved in the SEARCH study, and to date it is the biggest and most diverse research investigation of diabetes among youth in the United States. More than 20,000 youths are participating in the study, drawn from diverse racial and ethnic backgrounds (SEARCH, 2021).

The SEARCH for Diabetes in Youth study identified the following trends among youth and adolescents:

  • During 2002–2015 there was a significant total increase in the numbers diagnosed with type 1 diabetes.
  • During 2002–2010 the most significant increase in type 1 diabetes was among Hispanic children and adolescents.
  • During 2011–2015, non-Hispanic Asian and Pacific Islander children and adolescents had the biggest significant increase in type 1 diabetes.
  • For the time period 2002–2015, there was a significant overall increase in type 2 diabetes in youth 10–19 years.
  • During the time frames 2002–2010 and 2011–2015, the rates of T2D among youth 10–19 years did not change among non-Hispanic whites, but there was a notable increase for all other groups, particularly non-Hispanic blacks.
    (SEARCH, 2021)