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Both type 1 and type 2 diabetes can occur in children and adolescents. Of the 230 million people affected by diabetes worldwide, 4.9 million have type 1 diabetes. Type 1 diabetes is the most common chronic disease in children in the developed countries. Classification of childhood diabetes has become increasingly difficult as better measures of genetic testing have identified different forms of monogenetic diabetes masquerading as type 1 diabetes. Also the distinction between type 1 and 2 is not always clear-cut, particularly in overweight adolescents. Every year approximately 70 000 children under the age of 15 develop type 1 diabetes worldwide. The paediatric incidence of type 1 diabetes is growing by 3–5% each year. “Diabetes is different in children” is the motto of World Diabetes Day announced by the International Diabetes Federation following the United Nations resolution on diabetes in December 2006 and dedicating the next triennium to diabetes in children and adolescents. Recent developments indicate that the efforts of diabetes teams implementing the new approaches in paediatric diabetes care are successful.
GOALS OF TREATMENT: REDUCING COMPLICATION RISK
The Diabetes Control and Complications Trial (DCCT) and its follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study confirmed that an improvement in long-term glucose control, as obtained with intensified insulin therapy, can also reduce the incidence of complications and delay the progression of existing complications in type 1 diabetes in paediatric patients.1 2 Although only a subgroup of adolescents participated in the DCCT, longitudinal studies in the paediatric population such as the Berlin Retinopathy Study have revealed comparable results (fig 1).3 Reductions in HbA1c lead to the most dramatic fall in the rate of retinopathy when HbA1c is above 9%, a level which is deemed unacceptable in most guidelines. In addition, lower rates of retinopathy are achieved with every further drop in HbA1c. In particular, …
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