Type 1 diabetes is one of the most common endocrine and metabolic conditions in childhood and the number of children developing this form of diabetes every year is increasing rapidly, especially among the youngest children. In a growing number of countries, type 2 diabetes is now also being diagnosed in children.
Challenges of type 1 diabetes in children
Insulin treatment is life-saving and lifelong. A person with type 1 diabetes needs to follow a structured self-management plan including insulin use and blood glucose monitoring, physical activity, and a healthy diet. In many countries, especially in low-income families, access to self-care tools including self-management education and also to insulin is limited and this may lead to severe handicap and early death in children with diabetes.
Many children and adolescents may find it difficult to cope emotionally with their condition. Diabetes can result in discrimination and may limit social relationships. It may also have an impact on how well a child does in school. The costs of treatment and monitoring equipment combined with the daily needs of a child with diabetes may place a serious financial and emotional burden on the whole family.
Incidence and prevalence of type 1 diabetes in children
Two international collaborative projects, the Diabetes Mondiale study (DiaMond) 1 , the Europe and Diabetes study (EURODIAB) 2 and more recently in the USA the SEARCH for Diabetes in Youth study 3 , have been instrumental in monitoring trends in incidence (the number of people developing diabetes in a year). This has been done through setting-up of population-based regional or national registries using standardised definitions, data collection forms, and methods for validation.
The incidence of type 1 diabetes among children is increasing in many countries, at least in those under the age of 15 years. There are strong indications of geographic differences in trends but the overall annual increase is estimated to be around 3%. Evidence shows that incidence is increasing more steeply in some central and eastern European countries where the disease is less common. Also, several European studies have suggested that, in relative terms, increases are greatest among younger children.
There is also evidence that similar trends exist in many other parts of the world, but in sub-Saharan Africa incidence data are sparse or non–existent. Special efforts must be made to collect data, especially in those countries where diagnosis may be missed.
Some 78,000 children under 15 years are estimated to develop type 1 diabetes annually worldwide. Of the estimated 490,000 children living with type 1 diabetes, 24% come from the European Region, where the most reliable and up-to-date estimates of incidence are available, and 23% from the South-East Asia Region.
Type 2 diabetes in the young
There is evidence that type 2 diabetes in children and adolescents is increasing in some countries, however reliable data are sparse. As with type 1 diabetes, many children with type 2 diabetes risk developing complications in early adulthood, which would place a significant burden on the family and society. With increasing levels of obesity and physical inactivity in childhood in many countries, type 2 diabetes in childhood has the potential to become a global public health issue leading to serious health outcomes. More information about this aspect of the diabetes epidemic is urgently needed.
1: D.I.A.M.O.N.D. Project Group. Incidence and trends of childhood Type 1 diabetes worldwide 1990-1999. Diabet Med 2006; 23 (8): 857-866.
2: Patterson CC, Dahlquist GG, Gyürüs E, et al. Incidence trends for childhood type 1 diabetes in Europe during 1989-2003 and predicted new cases 2005-20: a multicentre prospective registration study. Lancet 2009; 373 (9680): 2027-2033.
3: S.E.A.R.C.H. for Diabetes in Youth Study Group , Liese AD, D'Agostino RB, et al. The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study. Pediatrics 2006; 118 (4): 1510-1518.