What are the characteristics of Diabetes Mellitus (DM) in pediatric patients?

From the Guidelines

Diabetes in children is primarily managed through a combination of insulin therapy, blood glucose monitoring, dietary management, and regular physical activity, with a focus on individualized care and comprehensive support for the child and their family, as recommended by the most recent guidelines 1.

Key Characteristics of Diabetes Mellitus in Pediatric Patients

The management of diabetes in children involves several key components, including:

• Insulin replacement therapy, which is essential for type 1 diabetes and may be necessary for type 2 diabetes in certain cases, with dosing individualized based on the child's weight, age, and blood glucose patterns 1
• Blood glucose monitoring, with target ranges typically between 70-180 mg/dL, and the use of continuous glucose monitors (CGMs) for real-time glucose readings 1
• Dietary management, including carbohydrate counting and meal plans designed to match insulin doses, as well as encouragement of healthy eating habits and regular physical activity 1
• Regular medical follow-ups every 3-4 months to adjust treatment as the child grows, and to assess for potential complications and comorbidities 1

Psychosocial Support and Family Involvement

In addition to medical management, psychosocial support and family involvement are critical components of diabetes care in children, including:

• Assessment of psychosocial issues and family stresses that could impact diabetes management, and provision of appropriate referrals to trained mental health professionals 1
• Encouragement of developmentally appropriate family involvement in diabetes management tasks, recognizing that premature transfer of diabetes care responsibility to the youth can result in diabetes burnout and suboptimal diabetes management 1
• Consideration of social determinants of health, such as food security, housing stability, and health literacy, in treatment decisions 1

Physical Activity and Exercise

Physical activity and exercise are also important components of diabetes management in children, with recommendations including:

• Encouragement of moderate-to-vigorous exercise for at least 60 minutes daily, and limitation of nonacademic "screen time" to less than 2 hours a day 1
• Individualization of blood glucose targets prior to physical activity and exercise, based on the type, intensity, and duration of activity, and consideration of additional carbohydrate intake during and/or after exercise to prevent hypoglycemia 1
• Monitoring of weight status and encouragement of healthy diet, exercise, and healthy weight as key components of pediatric type 1 diabetes care, recognizing the association between obesity and cardiovascular risk factors in children with type 1 diabetes 1

From the FDA Drug Label

The safety and effectiveness of Insulin Glargine to improve glycemic control in pediatric patients with diabetes mellitus have been established Use of Insulin Glargine for this indication is supported by evidence from an adequate and well-controlled study (Study D) in 174 Insulin Glargine-treated pediatric patients aged 6 to 15 years with type 1 diabetes mellitus

The characteristics of Diabetes Mellitus (DM) in pediatric patients are not directly described in the provided drug labels. However, the labels mention a study (Study D) that included pediatric patients with type 1 diabetes mellitus, which provides some information about this population:

• The average age was 11.7 years.
• The majority of patients were White (97%) and 52% were male.
• The mean BMI was approximately 18.9 kg/m2.
• The mean duration of diabetes was 5 years.
• Pediatric patients with type 1 diabetes had a higher incidence of severe symptomatic hypoglycemia compared to adults in studies with type 1 diabetes. 2

From the Research

Characteristics of Diabetes Mellitus (DM) in Pediatric Patients

• The incidence of type 1 diabetes mellitus in childhood and adolescence is steadily rising, with 22.9 new cases per year per 100 000 persons up to age 15 3
• Pediatric patients with type 2 diabetes are often characterized by obesity and experience a more rapid disease progression than adults with type 2 diabetes 4
• Common presenting symptoms of diabetes mellitus in pediatric patients include polydipsia, polyuria, and weight loss 3

Treatment and Management

• The primary goal of treatment of type 1 diabetes mellitus (T1DM) in children and adolescents is to maintain near-normoglycemia through intensive insulin therapy, avoid acute complications, and prevent long-term microvascular and macrovascular complications 5
• Treatment of type 2 diabetes in children includes lifestyle changes and pharmacotherapy, which is limited to metformin, liraglutide, and insulin, with emphasis on weight loss and optimal glycemic control 4
• Long-term insulin therapy can be delivered either by subcutaneous injection or by an insulin pump, with the goal of near-normalization of glucose metabolism (HbA1c <7.5%) 3

Acute Complications and Emergency Management

• Children with diabetes mellitus are at high risk for acute life-threatening complications of their chronic disease, including hyperglycemic emergencies 6
• Key features in treating pediatric patients with hyperglycemic emergencies include rapid fluid resuscitation when indicated, initiation of insulin, and addressing complicating comorbidities 6

Education and Multidisciplinary Team Care

• A multidisciplinary team approach, including patient-centered adjustments of food and insulin based upon blood glucose data, is essential for optimizing blood glucose control in type 1 diabetes mellitus 7
• Patient and parents should be empowered to analyze their own data, identify patterns, solve problems with food and activity, and do so based upon actual blood glucose results, to improve treatment outcomes 7