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The world of childhood diabetes has seen more changes in clinical care being introduced in recent years than many subspecialty areas of clinical practice. This review identifies some of the key underlying evidence and considers the implications for clinical teams that personal experience of these developments has highlighted.
The last 5 years have been a particularly exciting time in diabetes medicine with dramatic implications for a few patients. There have been advances in our understanding of the genetic basis of disease, and furthermore, technological advances in monitoring glycaemic control and delivering insulin leading to significant changes in the provision of care to many children with diabetes. This article focuses on a few major discoveries in recent years that have impacted on the diagnosis and treatment of young people with diabetes attending my clinical service.
Diagnosis of diabetes
The diagnosis of diabetes is now classified into four main groups:
▶ type 1 diabetes (T1D) associated with autoimmune insulin deficiency
▶ type 2 diabetes (T2D) characterised by insulin resistance
▶ other types of diabetes such as genetic forms, which include various causes of neonatal diabetes and maturity onset of diabetes in youth
▶ gestational diabetes.
Type 2 diabetes
The distinction between T1D and T2D is critically important because the therapeutic approaches are completely distinct. T1D requires immediate treatment with insulin to avoid death whereas lifestyle changes combined with insulin-sensitising agents, and sometimes in the longer term, insulin therapy form the mainstay of established treatment for T2D. T2D should be suspected in the presence of other features of insulin resistance, including obesity, hyperlipidaemia, increased blood pressure, acanthosis nigricans, ovarian hyperandrogenism and non-alcoholic fatty liver disease.1 However, insulin secretion in T2D has been shown to vary markedly from elevated levels to absolute deficiency. In children with features suggestive of T2D, assessment of insulin reserve through glucose tolerance testing has …