Diabetes treatment

During the last decade, insulin pump therapy has gained widespread acceptance in the treatment of children and adolescents with type 1 diabetes. In some of the European and North American paediatric diabetes centres, more than half of the young people with diabetes try to simulate a normal pattern of insulin secretion by means of an insulin pump (continuous subcutaneous insulin infusion).

As the diabetes epidemic grows in size and complexity, there is an increasing realization that physicians alone are unable to provide the care required by people with diabetes. To help them live life to the fullest, people with the condition need the services of a range of healthcare personnel, including diabetes nurses, dietitians, podiatrists, psychologists and eye specialists. The role of most of these is well defined; the multi-disciplinary team approach benefits increasing numbers of people with diabetes worldwide.

Adolescence, the period of transition from childhood to adulthood, is a key phase of human development. It is characterized by rapid changes – physical, sexual, psychological, emotional, cognitive, and social. The psychological imbalance that prevails during adolescence is particularly significant in people with diabetes as it often leads to a decline in self-care. This brings about a deterioration in blood glucose control, and creates difficulties that hamper the development of harmonious relationships between the young person with diabetes and his or her healthcare providers.

Diabetes is a leading cause of death in most developed countries, and has become a serious epidemic in many developing and newly industrialized nations. Currently, an estimated 246 million people worldwide have diabetes. Poorly controlled diabetes is associated with disabling and potentially life-threatening complications such as eye disease, kidney disease, nerve damage and cardiovascular disease. Until recently, lowering fasting and pre-meal glucose levels was a key focus of diabetes management.

The USA ranks third in the global prevalence of diabetes, preceded only by India and China. About 7% of the population has diabetes. A third of the total number of people with the condition is believed to be undiagnosed and therefore not receiving treatment to reduce the risk of disabling and life-threatening diabetes complications. The economic costs of diabetes are enormous – estimated at 132 billion USD in 2002. The mission of the US National Diabetes Education Program (NDEP) is to reduce diabetes-related illness and death.

Fasting during Ramadan, one of the five pillars of Islam, is an obligatory duty for all healthy adult Muslims. Ramadan, a lunar month, can last for 29 or 30 days, and its timing changes with respect to seasons. Depending on the geographical location

Left untreated, diabetic ketoacidosis has a 100% death rate. Indeed, ketoacidosis is a leading cause of death and disability in children with type 1 diabetes. Severe acidosis often develops during an extended period in which hyperglycaemia-related symptoms are misdiagnosed. Reducing this period may be sufficient to prevent severe acidosis in newly diagnosed children with diabetes.

Puberty is a period of rapid and radical physical, psychological and social change during which a child, in physiological terms, becomes an adult capable of reproduction. Adolescence refers as much to the psychosocial characteristics of development during puberty as to the physical changes. Adolescents with diabetes, who need to adhere to a complex medical regimen based around self-care throughout this period of development, face a series of particular and considerable challenges.

For many young people and their parents, nocturnal hypoglycaemia is perhaps the most feared short-term complication of diabetes. Intensive diabetes control is beneficial for all people with the condition – maintaining good blood glucose control overnight is critical in reducing the body’s exposure to high glucose levels. But it increases the risk of a dangerous drop in blood glucose levels while people are asleep. David Dunger and Roman Hovorka describe the problem of nocturnal hypoglycaemia and look forward to future developments that might reduce and eventually eradicate the risks.