Children

The importance of identifying children who are at risk of developing the metabolic syndrome cannot be underestimated. The syndrome is a cluster of risk factors

In many cases, overweight and obesity in children constitute a grim warning for future health: if no action is taken, an overweight or obese child is likely to grow into an overweight or obese adult with a series of chronic health problems – among them, type 2 diabetes. Indeed, obesity-related health conditions, including the metabolic syndrome – a strong risk factor for cardiovascular diseases – are increasingly prevalent among children around the world.

Most young people’s lives are hectic. They all involve a degree of chaos, and the usual trials and tribulations of friendships, romance, college, and so on. Add the diabetes into the mix, with its unique challenges, and the situation can feel overwhelming. The authors of this report, young people who have been living with diabetes for some years, have all met several diabetes healthcare providers. Unfortunately, although many adults involved in diabetes care are keen to help young people to make the most of their life, this does not always appear to be the case.

Ground-breaking research findings from the end of the last century demonstrated that the disabling and potentially life-threatening chronic complications of type 1 diabetes can be delayed or prevented by early and intensive blood glucose control. However, this strict and demanding regimen can present a major challenge for young people with the condition.

During a meeting halfway through a 24-month project for the UK National Institute for Health and Clinical Excellence (NICE), surrounded by well-known health professionals, Barbara Elster was asked her opinion on one of the subjects under discussion. Having expressed her views, she contemplated how she, a person with no formal medical training, had come to be in such esteemed medical company, involved in producing national guidelines on diabetes for the UK Government.

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).

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.

Type 2 diabetes has become the most common metabolic disorder. Its prevalence is growing most rapidly among people in the developing world, primarily due to the rapid demographic and epidemiological changes in these regions. According to IDF, India currently leads the world with an estimated 41 million people with diabetes; this figure is predicted to increase to 66 million by 2025. The diabetes epidemic is more pronounced in urban areas in India, where rates of diabetes are roughly double those in rural areas.

Breastfeeding has numerous advantages for mothers with diabetes and their babies. Nursing mothers have lower insulin requirements and better control of their blood glucose; breastfed babies may have a lower risk of developing diabetes themselves. Alison Stuebe describes these potential benefits and highlights the special needs of breastfeeding mothers with diabetes.

Children around the world are becoming increasingly vulnerable to overweight and obesity. The International Obesity Taskforce estimates that around 45 million of the world’s school-age children are obese – about 3% of the population of children under 5 years old. It is widely recognized that the modern transformation of lifestyles, including widespread sedentary behaviours and dramatic increases in the consumption of foods that are high in fat and sugar and low in nutrients, are behind the pandemic of obesity-related conditions, including type 2 diabetes.