COMPLICATIONS OF TYPE 1 DIABETES MELITUS IN CHILDREN
Keywords:
type 1 diabetes mellitus, children, complications
Abstract
The World Health Organization has defined Diabetes mellitus as a disorder of metabolism of various causes, due to lack of secretion and / or action of insulin, with long-term hyperglycemia and altered metabolism of sugars, proteins and fats.
Diabetes mellitus is the most widespread chronic non-infectious disease, with an increase in the frequency in childhood that could be the epidemic of the 21st century.The incidence is rapidly increasing in the world, while in the last thirty years in Serbia there has been an increase in the number of patients especially in the group of small and preschool children.
Exposure to the genetic, immune and environmental factors plays an important role in the etiology of the disease, but the underlying mechanisms remain unknown.
Weeks before the final diagnosis, weakness, irresistible hunger, weight loss, increased thirst, pronounced diuresis, drying of the mucous membranes, skin pruritus, blurred vision could be present.
Inadequate glycemic control and unregulated lipid status of children with type 1 diabetes are compatible with numerous complications and a higher risk of cardiovascular, peripheral vascular and cerebrovascular diseases.
The therapy consists of insulin therapy, adequate daily physical activity, a variety of diets, overcoming stressful life situations and maintaining satisfactory metabolic control. By using intensive insulin therapy, the best control of the disease is achieved, while the frequency of possible complications is reduced.
References
1. World Health Organiziation. (2016). Global report on diabetes. World Health Organization. Dostupno na sajtu: https://apps.who.int/iris/bitstream/handle/10665/204871/9789241565257_eng.pdf? [Posećeno 3. Avgusta 2020].
2. Alemzadeh R, Ali O. Diabetes mellitus in children. In: Kliegman R, Stanton B, Geme JS, Schor NF, editors. Nelson textbook of Pediatrics, 20th ed. Philadelphia, PA: Elsevier; 2016. p. 2163-2180.
3. Chiang JL, Maahs DM, Garvey KC, Hood KK, Laffel LM, Weinzimer SA, et al.Type 1 Diabetes in Children and Adolescents: A Position Statement by the American Diabetes AssociationDiabetes Care. 2018 Sep;41(9):2026-2044. doi: 10.2337/dci18-0023. Epub 2018 Aug 9. PMID:30093549
4. Republička i stručna komisija za izradu i implementaciju vodiča dobre kliničke prakse. Nacionalni vodič dobre kliničke prakse za dijagnostiku i lečenje diabetes mellitusa. Drugo izmenjeno i dopunjeno izdanje, novembar 2012. Beograd: Ministarstvo zdravlja Republike Srbije. Dostupno na sajtu: https://www.zdravlje.gov.rs/view_file.php?file_id=656&cache=sr [Posećeno 3. Avgusta 2020].
5. Rakočević I, Miljuš D, Božić Z. Incidencija i mortalitet od dijabetesa u Srbiji 2018. Registar za dijabetes u Srbiji, izveštaj br.13, Beograd: Institut za javno zdravlje Srbije „Milan Jovanović Batut“; 2018. Dostupno na sajtu: http://www.batut.org.rs/download/publikacije/2018IzvestajDijabetes.pdf [Posećeno 3. Avgusta 2020].
6. American Diabetes Association. Standards of Medical Care in Diabetes-2017 Abridged for Primary Care Providers. Clin Diabetes. 2017;35(1):5-26. doi:10.2337/cd16-0067
7. Cameron FJ, Wherrett DK. Care of diabetes in children and adolescents: controversies, changes, and consensus. Lancet. 2015;385(9982):2096-2106. doi:10.1016/S0140-6736(15)60971-0
8. Feltbower RG, Bodansky HJ, Patterson CC, et al. Acute complications and drug misuse are important causes of death for children and young adults with type 1 diabetes: results from the Yorkshire Register of diabetes in children and young adults. Diabetes Care. 2008;31(5):922-926. doi:10.2337/dc07-2029
9. Karges B, Kapellen T, Wagner VM, et al. Glycated hemoglobin A1c as a risk factor for severe hypoglycemia in pediatric type 1 diabetes. Pediatr Diabetes. 2017;18(1):51-58. doi:10.1111/pedi.12348
10. Karges B, Rosenbauer J, Holterhus PM, et al. Hospital admission for diabetic ketoacidosis or severe hypoglycemia in 31,330 young patients with type 1 diabetes. Eur J Endocrinol. 2015;173(3):341-350. doi:10.1530/EJE-15-0129
11. Cho YH, Craig ME, Donaghue KC. Puberty as an accelerator for diabetes complications. Pediatr Diabetes. 2014;15(1):18-26. doi:10.1111/pedi.12112
12. Jenkins A, Januszewski A, O'Neal D. The early detection of atherosclerosis in type 1 diabetes: why, how and what to do about it. Cardiovasc Endocrinol Metab. 2019;8(1):14–27. Published 2019 Feb 13. doi:10.1097/XCE.0000000000000169
13. Groop PH, Thomas MC, Moran JL, et al. The presence and severity of chronic kidney disease predicts all-cause mortality in type 1 diabetes. Diabetes. 2009;58(7):1651-1658. doi:10.2337/db08-1543
14. Huo L, Shaw JE, Wong E, Harding JL, Peeters A, Magliano DJ. Burden of diabetes in Australia: life expectancy and disability-free life expectancy in adults with diabetes. Diabetologia. 2016;59(7):1437-1445. doi:10.1007/s00125-016-3948-x
15. Cho YH, Craig ME, Hing S, et al. Microvascular complications assessment in adolescents with 2- to 5-yr duration of type 1 diabetes from 1990 to 2006 [published correction appears in Pediatr Diabetes. 2012 Feb;13(1):135]. Pediatr Diabetes. 2011;12(8):682-689. doi:10.1111/j.1399-5448.2011.00762.x
16. Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, et al. 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(14):977-986. doi:10.1056/NEJM199309303291401.
17. Chillarón JJ, Flores Le-Roux JA, Benaiges D, Pedro-Botet J. Type 1 diabetes, metabolic syndrome and cardiovascular risk. Metabolism. 2014;63(2):181-187. doi:10.1016/j.metabol.2013.10.002
18. Purnell JQ, Zinman B, Brunzell JD; DCCT/EDIC Research Group. The effect of excess weight gain with intensive diabetes mellitus treatment on cardiovascular disease risk factors and atherosclerosis in type 1 diabetes mellitus: results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC) study. Circulation. 2013;127(2):180‐187. doi:10.1161/CIRCULATIONAHA.111.077487
19. Šimonienė D, Platūkiene A, Prakapienė E, Radzevičienė L, Veličkiene D. Insulin Resistance in Type 1 Diabetes Mellitus and Its Association with Patient's Micro- and Macrovascular Complications, Sex Hormones, and Other Clinical Data. Diabetes Ther. 2020;11(1):161‐174. doi:10.1007/s13300-019-00729-5
20. Stankute I, Dobrovolskiene R, Danyte E, et al. Factors Affecting Cardiovascular Risk in Children, Adolescents, and Young Adults with Type 1 Diabetes. J Diabetes Res. 2019;2019:9134280. Published 2019 May 16. doi:10.1155/2019/9134280
21. Homma TK, Endo CM, Saruhashi T, Mori API, de Noronha RM, Monte O. et al. Dyslipidemia in young patients with type 1 diabetes mellitus. Arch Endocrinol Metab. 2015 Jun; 59(3): 215–219. doi: 10.1590/2359-3997000000040
22. Parthasarathy L, Chiplonkar S, Khadilkar V, Khadilkar A. Association Between Metabolic Control and Lipid Parameters in Indian Children with Type 1 Diabetes. Indian Pediatr. 2016;53(1):39-41. doi:10.1007/s13312-016-0787-2
23. El Bakry MM, Mansour AI, Ahmed ME, Sptan HE. Dyslipidemia in Egyptian children and adolescents with type 1 diabetes mellitus. Benha Med J 2017;34:104-7.
24. Salem M, Moneir I, Adly AM, Esmat K. Study of coronary artery calcification risk in Egyptian adolescents with type-1 diabetes. Acta Diabetol. 2011;48(1):41-53. doi:10.1007/s00592-010-0214-4
25. Sherwani SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of HbA1c Test in Diagnosis and Prognosis of Diabetic Patients. Biomark Insights. 2016;11:95-104. Published 2016 Jul 3. doi:10.4137/BMI.S38440
26. Beraki Å, Magnuson A, Särnblad S, Åman J, Samuelsson U. Increase in physical activity is associated with lower HbA1c levels in children and adolescents with type 1 diabetes: results from a cross-sectional study based on the Swedish pediatric diabetes quality registry (SWEDIABKIDS). Diabetes Res Clin Pract. 2014;105(1):119-125. doi:10.1016/j.diabres.2014.01.029
27. DuBose SN, Hermann JM, Tamborlane WV, et al. Obesity in Youth with Type 1 Diabetes in Germany, Austria, and the United States. J Pediatr. 2015;167(3):627-32.e324. doi:10.1016/j.jpeds.2015.05.046.
28. Gourgari E, Dabelea D, Rother K. Modifiable Risk Factors for Cardiovascular Disease in Children with Type 1 Diabetes: Can Early Intervention Prevent Future Cardiovascular Events?. Curr Diab Rep. 2017;17(12):134. Published 2017 Nov 3. doi:10.1007/s11892-017-0968-y
29. Tonoli C, Heyman E, Roelands B, et al. Type 1 diabetes-associated cognitive decline: a meta-analysis and update of the current literature. J Diabetes. 2014;6(6):499-513. doi:10.1111/1753-0407.12193
30. Seaquist ER. The Impact of Diabetes on Cerebral Structure and Function. Psychosom Med. 2015;77(6):616-621. doi:10.1097/PSY.0000000000000207
2. Alemzadeh R, Ali O. Diabetes mellitus in children. In: Kliegman R, Stanton B, Geme JS, Schor NF, editors. Nelson textbook of Pediatrics, 20th ed. Philadelphia, PA: Elsevier; 2016. p. 2163-2180.
3. Chiang JL, Maahs DM, Garvey KC, Hood KK, Laffel LM, Weinzimer SA, et al.Type 1 Diabetes in Children and Adolescents: A Position Statement by the American Diabetes AssociationDiabetes Care. 2018 Sep;41(9):2026-2044. doi: 10.2337/dci18-0023. Epub 2018 Aug 9. PMID:30093549
4. Republička i stručna komisija za izradu i implementaciju vodiča dobre kliničke prakse. Nacionalni vodič dobre kliničke prakse za dijagnostiku i lečenje diabetes mellitusa. Drugo izmenjeno i dopunjeno izdanje, novembar 2012. Beograd: Ministarstvo zdravlja Republike Srbije. Dostupno na sajtu: https://www.zdravlje.gov.rs/view_file.php?file_id=656&cache=sr [Posećeno 3. Avgusta 2020].
5. Rakočević I, Miljuš D, Božić Z. Incidencija i mortalitet od dijabetesa u Srbiji 2018. Registar za dijabetes u Srbiji, izveštaj br.13, Beograd: Institut za javno zdravlje Srbije „Milan Jovanović Batut“; 2018. Dostupno na sajtu: http://www.batut.org.rs/download/publikacije/2018IzvestajDijabetes.pdf [Posećeno 3. Avgusta 2020].
6. American Diabetes Association. Standards of Medical Care in Diabetes-2017 Abridged for Primary Care Providers. Clin Diabetes. 2017;35(1):5-26. doi:10.2337/cd16-0067
7. Cameron FJ, Wherrett DK. Care of diabetes in children and adolescents: controversies, changes, and consensus. Lancet. 2015;385(9982):2096-2106. doi:10.1016/S0140-6736(15)60971-0
8. Feltbower RG, Bodansky HJ, Patterson CC, et al. Acute complications and drug misuse are important causes of death for children and young adults with type 1 diabetes: results from the Yorkshire Register of diabetes in children and young adults. Diabetes Care. 2008;31(5):922-926. doi:10.2337/dc07-2029
9. Karges B, Kapellen T, Wagner VM, et al. Glycated hemoglobin A1c as a risk factor for severe hypoglycemia in pediatric type 1 diabetes. Pediatr Diabetes. 2017;18(1):51-58. doi:10.1111/pedi.12348
10. Karges B, Rosenbauer J, Holterhus PM, et al. Hospital admission for diabetic ketoacidosis or severe hypoglycemia in 31,330 young patients with type 1 diabetes. Eur J Endocrinol. 2015;173(3):341-350. doi:10.1530/EJE-15-0129
11. Cho YH, Craig ME, Donaghue KC. Puberty as an accelerator for diabetes complications. Pediatr Diabetes. 2014;15(1):18-26. doi:10.1111/pedi.12112
12. Jenkins A, Januszewski A, O'Neal D. The early detection of atherosclerosis in type 1 diabetes: why, how and what to do about it. Cardiovasc Endocrinol Metab. 2019;8(1):14–27. Published 2019 Feb 13. doi:10.1097/XCE.0000000000000169
13. Groop PH, Thomas MC, Moran JL, et al. The presence and severity of chronic kidney disease predicts all-cause mortality in type 1 diabetes. Diabetes. 2009;58(7):1651-1658. doi:10.2337/db08-1543
14. Huo L, Shaw JE, Wong E, Harding JL, Peeters A, Magliano DJ. Burden of diabetes in Australia: life expectancy and disability-free life expectancy in adults with diabetes. Diabetologia. 2016;59(7):1437-1445. doi:10.1007/s00125-016-3948-x
15. Cho YH, Craig ME, Hing S, et al. Microvascular complications assessment in adolescents with 2- to 5-yr duration of type 1 diabetes from 1990 to 2006 [published correction appears in Pediatr Diabetes. 2012 Feb;13(1):135]. Pediatr Diabetes. 2011;12(8):682-689. doi:10.1111/j.1399-5448.2011.00762.x
16. Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, et al. 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(14):977-986. doi:10.1056/NEJM199309303291401.
17. Chillarón JJ, Flores Le-Roux JA, Benaiges D, Pedro-Botet J. Type 1 diabetes, metabolic syndrome and cardiovascular risk. Metabolism. 2014;63(2):181-187. doi:10.1016/j.metabol.2013.10.002
18. Purnell JQ, Zinman B, Brunzell JD; DCCT/EDIC Research Group. The effect of excess weight gain with intensive diabetes mellitus treatment on cardiovascular disease risk factors and atherosclerosis in type 1 diabetes mellitus: results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC) study. Circulation. 2013;127(2):180‐187. doi:10.1161/CIRCULATIONAHA.111.077487
19. Šimonienė D, Platūkiene A, Prakapienė E, Radzevičienė L, Veličkiene D. Insulin Resistance in Type 1 Diabetes Mellitus and Its Association with Patient's Micro- and Macrovascular Complications, Sex Hormones, and Other Clinical Data. Diabetes Ther. 2020;11(1):161‐174. doi:10.1007/s13300-019-00729-5
20. Stankute I, Dobrovolskiene R, Danyte E, et al. Factors Affecting Cardiovascular Risk in Children, Adolescents, and Young Adults with Type 1 Diabetes. J Diabetes Res. 2019;2019:9134280. Published 2019 May 16. doi:10.1155/2019/9134280
21. Homma TK, Endo CM, Saruhashi T, Mori API, de Noronha RM, Monte O. et al. Dyslipidemia in young patients with type 1 diabetes mellitus. Arch Endocrinol Metab. 2015 Jun; 59(3): 215–219. doi: 10.1590/2359-3997000000040
22. Parthasarathy L, Chiplonkar S, Khadilkar V, Khadilkar A. Association Between Metabolic Control and Lipid Parameters in Indian Children with Type 1 Diabetes. Indian Pediatr. 2016;53(1):39-41. doi:10.1007/s13312-016-0787-2
23. El Bakry MM, Mansour AI, Ahmed ME, Sptan HE. Dyslipidemia in Egyptian children and adolescents with type 1 diabetes mellitus. Benha Med J 2017;34:104-7.
24. Salem M, Moneir I, Adly AM, Esmat K. Study of coronary artery calcification risk in Egyptian adolescents with type-1 diabetes. Acta Diabetol. 2011;48(1):41-53. doi:10.1007/s00592-010-0214-4
25. Sherwani SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of HbA1c Test in Diagnosis and Prognosis of Diabetic Patients. Biomark Insights. 2016;11:95-104. Published 2016 Jul 3. doi:10.4137/BMI.S38440
26. Beraki Å, Magnuson A, Särnblad S, Åman J, Samuelsson U. Increase in physical activity is associated with lower HbA1c levels in children and adolescents with type 1 diabetes: results from a cross-sectional study based on the Swedish pediatric diabetes quality registry (SWEDIABKIDS). Diabetes Res Clin Pract. 2014;105(1):119-125. doi:10.1016/j.diabres.2014.01.029
27. DuBose SN, Hermann JM, Tamborlane WV, et al. Obesity in Youth with Type 1 Diabetes in Germany, Austria, and the United States. J Pediatr. 2015;167(3):627-32.e324. doi:10.1016/j.jpeds.2015.05.046.
28. Gourgari E, Dabelea D, Rother K. Modifiable Risk Factors for Cardiovascular Disease in Children with Type 1 Diabetes: Can Early Intervention Prevent Future Cardiovascular Events?. Curr Diab Rep. 2017;17(12):134. Published 2017 Nov 3. doi:10.1007/s11892-017-0968-y
29. Tonoli C, Heyman E, Roelands B, et al. Type 1 diabetes-associated cognitive decline: a meta-analysis and update of the current literature. J Diabetes. 2014;6(6):499-513. doi:10.1111/1753-0407.12193
30. Seaquist ER. The Impact of Diabetes on Cerebral Structure and Function. Psychosom Med. 2015;77(6):616-621. doi:10.1097/PSY.0000000000000207