Type 1 diabetes (T1D) is a complex and challenging disease, especially for youth and adolescents due to the biological and physical developmental stages from childhood to adulthood. To address the specific needs of youth and adolescents, the American Diabetes Association issued “Type 1 Diabetes in Children and Adolescents: A Position Statement by the American Diabetes Association” today, which is available online and will be published in the September 2018 print issue of Diabetes Care.
A team of eight pediatric diabetes authorities from leading institutions and diabetes care centers across the United States convened to create the position statement, which is comprised of recommendations and guidelines based on the body of evidence from over 190 pieces of literature, including research studies and consensus reports. The panel noted that while adult clinical trials in T1D have produced fairly robust evidence which have advanced care and improved outcomes, large, randomized pediatric clinical trials are challenging to recruit for and complete. Thus, this is the first updated ADA pediatric T1D position statement since 2005 and the majority of recommendations for youth with T1D rely on supportive evidence from cohort/registry studies or expert consensus and clinical experience.
The statement contains guidelines on T1D staging, screenings and T1D diagnosis, including the importance of distinguishing between type 1 diabetes, type 2 diabetes, monogenic diabetes and other forms of diabetes. Specific information is provided on blood glucose management, lower blood glucose and HbA1c targets with details outlining self-blood glucose monitoring, the increasing use of continuous glucose monitoring and novel automated insulin delivery systems. The authors note that there are improved outcomes for patients when there is adequate payor reimbursement for the numerous supplies and devices needed to optimize T1D management, especially in the pediatric population.
Proper lifestyle management (nutrition, exercise) for youth with T1D is also emphasized, as well as complications of T1D and the behavioral aspects of self-management that clinicians should be familiar with, including potential depression, anxiety and eating disorders. The statement also addresses the specific needs of adolescent patients and the challenges that arise within this age group, including making the transition to self-care and the dangers of high-risk behavior among adolescent patients. The statement stresses that providers should encourage developmentally appropriate family involvement in diabetes management tasks for children and adolescents and cite that premature transfer of diabetes care from the pediatric to the adult care setting may result in poor self-management behaviors and deterioration in glycemic control.
“It is critical for us to remember that children are not little adults, thus, pediatric-onset diabetes is different from adult-onset diabetes due to its distinct epidemiology, pathophysiology, developmental considerations and response to therapy,” said senior author Desmond Schatz, MD, Professor of Pediatrics and Medical Director of the Diabetes Center, and Director of the Clinical Research Center within the Clinical and Translational Science Institute at the University of Florida, Gainesville, and the ADA’s 2016 President of Science and Medicine. “Clinicians must be mindful of a child’s current and evolving developmental stages and must adapt care plans, particularly during the adolescent years, in order to maximize glycemic control and appropriately support the needs of both the patient and their family.”
The availability of ever-improving technology devices to assist in diabetes care is credited with providing advances in T1D research, treatment and management, however, the authors cite the need for more studies in the pediatric population to address and support the unique characteristics of T1D during each developmental stage from youth and adolescence to adulthood.