Release Date: 2023-09-14

Type I Diabetes Mellitus in Children and Adolescents

Release Date: 2023-09-14

Type 1 diabetes mellitus (T1DM) in children and adolescents is characterized by the autoimmune destruction of pancreatic beta cells, resulting in absolute insulin deficiency. Its onset is typically abrupt, with symptoms such as polyuria, polydipsia, weight loss, and fatigue. Management focuses on maintaining blood glucose levels within target ranges to prevent acute complications like diabetic [...]

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Work TypeBook Chapter
Published inCurrent Perspective on Diabetes Mellitus in Clinical Sciences
First Page287
Last Page302
DOIhttps://doi.org/10.69860/nobel.9786053359111.27
ISBN978-605-335-911-1 (PDF)
LanguageENG
Page Count16
Copyright HolderNobel Tıp Kitabevleri
Licensehttps://nobelpub.com/publish-with-us/copyright-and-licensing
Type 1 diabetes mellitus (T1DM) in children and adolescents is characterized by the autoimmune destruction of pancreatic beta cells, resulting in absolute insulin deficiency. Its onset is typically abrupt, with symptoms such as polyuria, polydipsia, weight loss, and fatigue. Management focuses on maintaining blood glucose levels within target ranges to prevent acute complications like diabetic ketoacidosis (DKA) and long-term complications such as retinopathy and nephropathy. Treatment includes insulin therapy tailored to individual needs, balanced nutrition, regular physical activity, and ongoing blood glucose monitoring. Psychological support and education are crucial for patients and families to manage the challenges of living with T1DM effectively, ensuring optimal growth, development, and quality of life.

Muammer Buyukinan (Author)
Assistant Professor, Selcuk University
https://orcid.org/0000-0002-2937-823X

  • Atkinson MA, Eisenbarth GS. Type 1 diabetes: new perspectives on disease pathogenesis and treatment. Lancet. 2001;21;358(9277):221-9.

  • ElSayed NA, Aleppo G, Aroda VR, et al. 2. Classifi cation and Diagnosis of Diabetes: Standards of Care in Diabetes 2023. Diabetes Care. 2023 Jan 1;46(Suppl 1):S19-S40.

  • Gregory GA, Robinson TIG, Linklater SE, et al; International Diabetes Federation Diabetes Atlas Type 1 Diabetes in Adults Special Interest Group. Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: a modelling study. Lancet Diabetes Endocrinol. 2022 Oct;10(10):741-760.

  • Libman I, Haynes A, Lyons S, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Defi nition, epidemiology, and classifi cation of diabetes in children and adolescents. Pediatr Diabetes. 2022 Dec;23(8):1160- 1174.

  • Yeşilkaya E, Cinaz P, Andıran N, et al. First report on the nationwide incidence and prevalence of Type 1 diabetes among children in Turkey. Diabet Med. 2017 Mar;34(3):405-410.

  • Silink M. Childhood diabetes: a global perspective. Horm Res. 2002;57 Suppl 1:1-5.

  • Tillil H, Kobberling J. Age corrected empirical genetic risk estimates for fi rst-degree relatives of IDDM patients. Diabetes. 1987 Jan;36(1):93-9.

  • Cooper JD, Smyth DJ, Smiles AM, et al. Meta analysis of genome-wide association study data identifi es additional type 1 diabetes risk loci. Nat Genet. 2008;40(12):1399-401.

  • Atkinson MA, Maclaren NK. The pathogenesis of insulin dependent diabetes mellitus. N Engl J Med. 1994 Nov 24;331(21):1428-36.

  • Redondo MJ, Rewers M, Yu L, et al. Genetic determination of islet cell autoimmunity in monozygotic twin, dizygotic twin, and nontwin siblings of patients with type 1 diabetes: prospective twin study. BMJ. 1999 Mar 13;318(7185):698-702.

  • Rich SS, Erlich H, Concannon P. Genetics of Type 1 Diabetes. Chapter 12, In: Cowie CC, Casagrande SS, Menke A, Cissell MA, Eberhardt MS, Meigs JB, Gregg EW, Knowler WC, Barrett-Connor E, Becker DJ, Brancati FL, Boyko EJ, Herman WH, Howard BV, Narayan KMV, Rewers M, Fradkin JE, editors. Diabetes in America. 3rd ed. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases (US); 2018.

  • Davies JL, Kawaguchi Y, Bennett ST, et al. A genome wide search for human type 1 diabetes susceptibility genes. Nature. 1994;8;371(6493):130-6.

  • Mehers KL, Gillespie KM. The genetic basis for type 1 diabetes. Br Med Bull. 2008;88(1):115-29.

  • Vurallı D, Kandemir N. Tip 1 Diabetes Mellitus. Darendeliler F, Aycan Z, Kara C, Özen S, Eren E, ed. Çocuk Endokrinolojisi ve Diyabet, 1st edition (pp.1323-1398). İstanbul, İstanbul Tıp Kitapevi; 2021.

  • Thernlund GM, Dahlquist G, Hansson K, et al. Psychological stress and the onset of IDDM in children. Diabetes Care. 1995;18(10):1323-9.

  • Bach JF. The effect of infections on susceptibility to autoimmune and allergic diseases. N Engl J Med. 2002;19;347(12):911-20.

  • E, Savola K, Kulmala P, et al. Diabetes associated autoantibodies in relation to clinical characteristics and natural course in children with newly diagnosed type 1 diabetes. The Childhood Diabetes In Finland Study Group. J Clin Endocri- nol Metab. 1999;84(5):1534-9.

  • House DV, Winter WE. Autoimmune diabetes. The role of autoantibody markers in the prediction and prevention of insulin dependent diabetes mellitus. Clin Lab Med. 1997 Sep;17(3):499-545.

  • Thomson G, Robinson WP, Kuhner MK, et al. Genetic heterogeneity, modes of inheritance, and risk estimates for a joint study of Caucasians with insulin dependent diabetes mellitus. Am J Hum Genet. 1988 Dec;43(6):799-816.

  • Baekkeskov S, Aanstoot HJ, Christgau S, et al. Identifi cation of the 64K autoantigen in insulin dependent diabetes as the GABA synthesizing enzyme glutamic acid decarboxylase. Nature. 1990;13;347(6289):151- 6.

  • Ellis TM, Schatz DA, Ottendorfer EW, et al. The relationship between humoral and cellular immunity to IA-2 in IDDM. Diabetes. 1998;47(4):566-9.

  • Umpierrez GE, Latif KA, Murphy MB, et al. Thyroid dysfunction in patients with type 1 diabetes: a longitudinal study. Diabetes Care. 2003;26(4):1181-5.

  • JH, Barst RJ. Detection of familial primary pulmonary hypertension by genetic testing. N Engl J Med. 1997 Jul 17;337(3):202-3.

  • Jaeger C, Hatziagelaki E, Petzoldt R, Bretzel RG. Comparative analysis of organ specifi c autoantibodies and celiac disease associated antibodies in type 1 diabetic patients, their fi rst degree relatives, and healthy control subjects. Diabetes Care. 2001 Jan;24(1):27-32.

  • Besser REJ, Bell KJ, Couper JJ, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Stages of type 1 diabetes in children and adolescents. Pediatr Diabetes. 2022 Dec;23(8):1175-1187.

  • Nepom GT. MHC and autoimmune diseases. Immunol Ser. 1993;59:143-64.

  • Pietropaolo M, Becker DJ, LaPorte RE, et al. Progression to insulin-requiring diabetes in seronegative prediabetic subjects: the role of two HLA-DQ high-risk haplotypes. Diabetologia. 2002 Jan;45(1):66-76.

  • Achenbach P, Warncke K, Reiter J, et al. Stratifi cation of type 1 diabetes risk on the basis of islet autoantibody characteristics. Diabetes. 2004 Feb;53(2):384-92.

  • Winter WE, Harris N, Schatz D. Type 1 diabetes islet autoantibody markers. Diabetes Technol Ther. 2002;4(6):817-39.

  • Verge CF, Gianani R, Kawasaki E, et al. Prediction of type I diabetes in fi rst degree relatives using a combination of insulin, GAD, and ICA512bdc/IA-2 autoantibodies. Diabetes. 1996 Jul;45(7):926-33.

  • Ziegler AG, Hummel M, Schenker M, Bonifacio E. Autoantibody appearance and risk for development of childhood diabetes in offspring of parents with type 1 diabetes: the 2-year analysis of the German BABYDIAB Study. Diabetes. 1999 Mar;48(3):460-8.

  • Bingley PJ. Interactions of age, islet cell anti bodies, insulin autoantibodies, and fi rst phase insulin response in predicting risk of progression to IDDM in ICA+ relatives: the ICARUS data set. Islet Cell Antibody Register Users Study. Diabetes. 1996 Dec;45(12):1720-8.

  • Ward WK, LaCava EC, Paquette TL, Beard JC, Wallum BJ, Porte D, Jr. Disproportionate elevation of immunoreactive proinsulin in type 2 (non-insulin dependent) diabetes mellitus and in experimental insulin resistance. Diabetologia. 1987 Sep;30(9):698-702.

  • Spinas GA, Snorgaard O, Hartling SG, Oberholzer M, Berger W. Elevated proinsulin levels related to islet cell antibodies in fi rst degree relatives of IDDM patients. Diabetes Care. 1992 May;15(5):632-7.

  • Lin A, Mack JA, Bruggeman B, et al. Low-Dose ATG/GCSF in Established Type 1 Diabetes: A Five-Year Follow-up Report. Diabetes. 2021 May;70(5):1123-1129.

  • Cook JJ, Hudson I, Harrison LC, et al. Double blind controlled trial of azathioprine in children with newly diagnosed type I diabetes. Diabetes. 1989 Jun;38(6):779-83.

  • Gottlieb PA, Quinlan S, Krause-Steinrauf H, et al. Failure to preserve beta cell function with mycophenolate mofetil and daclizumab combined treatment in patients with new onset type 1 diabetes. Diabetes Care. 2010 Apr;33(4):826-32.

  • Bougneres PF, Landais P, Boisson C, et al. Limited duration of remission of insulin dependency in children with recent overt type I diabetes treated with lowdose cyclosporin. Diabetes. 1990 Oct;39(10):1264-72.

  • Christie MR, Molvig J, Hawkes CJ, Carstensen B, Mandrup Poulsen T. IA-2 antibody negative status predicts remission and recovery of C-peptide levels in type 1 diabetic patients treated with cyclosporin. Diabetes Care. 2002 Jul;25(7):1192-7.

  • Keymeulen B, Vandemeulebroucke E, Ziegler AG, et al. Insulin needs after CD3 antibody treatment in new onset type 1 diabetes. N Engl J Med. 2005 Jun 23;352(25):2598-608.

  • Muir A, Peck A, Clare-Salzler M, et al. Insulin immunization of nonobese diabetic mice induces a protective insulitis characterized by diminished intraislet interferon-gamma transcription. J Clin Invest. 1995 Feb;95(2):628-34.

  • Yagi N, Yokono K, Amano K, et al. Expression of intercellular adhesion molecule 1 on pancreatic beta cells accelerates beta-cell destruction by cytotoxic T-cells in murine autoimmune diabetes. Diabetes. 1995 Jul;44(7):744-52.

  • Kodama S, Kuhtreiber W, Fujimura S, Dale EA, Faustman DL. Islet regeneration during the reversal of autoimmune diabetes in NOD mice. Science. 2003 Nov 14;302(5648):1223-7.

  • Dor Y, Brown J, Martinez OI, Melton DA. Adult pancreatic beta-cells are formed by self duplication rather than stem-cell differentiation. Nature. 2004 May 6;429(6987):41-6.

  • Mastrandrea L, Yu J, Behrens T, et al. Etanercept treatment in children with new onset type 1 diabetes: pilot randomized, placebo controlled, double- blind study. Diabetes Care. 2009 Jul;32(7):1244-9.

  • Rother KI, Brown RJ, Morales MM, et al. Effect of ingested interferon α on beta-cell function in children with new-onset type 1 diabetes. Diabetes Care. 2009 Jul;32(7):1250-5.

  • Yamada K, Nonaka K, Hanafusa T, Miyazaki A, Toyoshima H, Tarui S. Preventive and therapeutic effects of large-dose nicotinamide injections on diabetes associated with insulitis. An observation in nonobese diabetic (NOD) mice. Diabetes. 1982 Sep;31(9):749-53.

  • Gale EA, Bingley PJ, Emmett CL, Collier T. European Nicotinamide Diabetes Intervention Trial (ENDIT): a randomised controlled trial of intervention before the onset of type 1 diabetes. Lancet. 2004 Mar 20;363(9413):925-31.

  • Hypponen E, Laara E, Reunanen A, Jarvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth cohort study. Lancet. 2001 Nov 3;358(9292):1500-3.

  • Raz I, Elias D, Avron A, Tamir M, Metzger M, Cohen IR. Beta cell function in new-onset type 1 diabetes and immunomodulation with a heat-shock protein peptide (DiaPep277): a randomised, double-blind, phase II trial. Lancet. 2001 Nov 24;358(9295):1749-53.

  • Santer R, Steinmann B, Schaub J. Fanconi Bickel syndrome a congenital defect of facilitative glucose transport. Curr Mol Med. 2002;2(2):213-27.

  • Skyler JS, Krischer JP, Wolfsdorf J, et al. Effects of oral insulin in relatives of patients with type 1 diabetes: The Diabetes Prevention Trial Type 1. Diabetes Care. 2005 May;28(5):1068-76.

  • Nanto-Salonen K, Kupila A, Simell S, et al. Nasal insulin to prevent type 1 diabetes in children with HLA genotypes and autoantibodies conferring increased risk of disease: a double blind, randomised controlled trial. Lancet. 2008 Nov 15;372(9651):1746-55.

  • Ludvigsson J, Faresjo M, Hjorth M, et al. GAD treatment and insulin secretion in recent onset type 1 diabetes. N Engl J Med. 2008 Oct 30;359(18):1909-20.

  • Calder PC. Polyunsaturated fatty acids, infl ammation, and immunity. Lipids. 2001 Sep;36(9):1007-24.

  • Knip M, Virtanen SM, Seppa K, et al. Dietary intervention in infancy and later signs of beta cell autoimmunity. N Engl J Med. 2010 Nov 11;363(20):1900-8.

  • Wan XX, Zhang DY, Khan MA, et al. Stem Cell Transplantation in the Treatment of Type 1 Diabetes Mellitus: From Insulin Replacement to Beta-Cell Replacement. Front Endocrinol (Lausanne). 2022 Mar 18;13:859638.

  • Lu J, Shen SM, Ling Q, et al. One Repeated Transplantation of Allogeneic Umbilical Cord Mesenchymal Stromal Cells in Type 1 Diabetes: An Open Parallel Controlled Clinical Study. Stem Cell Res Ther (2021) 12(1):340.

  • Araujo DB, Dantas JR, Silva KR, et al. Allogenic Adipose Tissue-Derived Stromal/Stem Cells and Vitamin D Supplementation in Patients With Recent-Onset Type 1 Diabetes Mellitus: A 3-Month Follow-Up Pilot Study. Front Immunol. 2020;11:993.

  • Dantas JR, Araujo DB, Silva KR, et al. Adipose Tissue-Derived Stromal/Stem Cells + Cholecalciferol: A Pilot Study in Recent-Onset Type 1 Diabetes Patients. Arch Endocrinol Metab. 2021; 65(3):342–51.

  • Keam, S.J. Teplizumab: First Approval. Drugs. 2023;83:439–445.

  • U.S Food and Drug Administration FDA approved drug products: TZIELD (teplizumab-mzwv) injection for intravenous use. [Last Cited on 27th January 2023] Available from: https://www.fda.gov/news-events/ press-announcements/ fda-approves-frst-drug-can-delay-onset-type-1-diabetes.

  • Misra S, Shukla AK. Teplizumab: type 1 diabetes mellitus preventable? Eur J Clin Pharmacol. 2023 May;79(5):609-616.

  • Sims EK, Bundy BN, Stier K, et al. Teplizumab improves and stabilizes beta cell function in antibodypositive high-risk individuals. Sci Transl Med. 2021;13(583):eabc8980.

  • Smigoc Schweiger D. Recent Advances in Immune-based Therapies for Type 1 Diabetes. Horm Res Paediatr. 2022 May 9. doi: 10.1159/000524866. Epub ahead of print.

  • Jefferson IG, Smith MA, Baum JD. Insulin dependent diabetes in under 5 year olds. Arch Dis Child 1985 Dec;60(12):1144-8.

  • Couper J, Donaghue K. Phases of diabetes. Pediatr Diabetes. 2007 Feb;8(1):44-7.

  • Pinkey JH, Bingley PJ, Sawtell PA, Dunger DB, Gale EA. Presentation and progress of childhood diabetes mellitus: a prospective population-based study. The Bart’s Oxford Study Group. Diabetologia. 1994 Jan;37(1):70-4.

  • Glaser N, Fritsch M, Priyambada L, et al. ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2022 Nov;23(7):835-856.

  • Komulainen J, Kulmala P, Savola K, et al. Clinical, autoimmune, and genetic characteristics of very young children with type 1 diabetes. Childhood Diabetes in Finland (DiMe) Study Group. Diabetes care. 1999;22(12):1950-5.

  • Lombardo F, Valenzise M, Wasniewska M, et al. Two year prospective evaluation of the factors affecting honeymoon frequency and duration in children with insulin dependent diabetes mellitus: the keyrole of age at diagnosis. Diabetes Nutr Metab. 2002 Aug;15(4):246-51.

  • de Bock M, Codner E, Craig ME, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes. Pediatr Diabetes. 2022 Dec;23(8):1270-1276.

  • Cengiz E, Danne T, Ahmad T, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Insulin treatment in children and adolescents with diabetes. Pediatr Diabetes. 2022 Dec;23(8):1277-1296.

  • Diabetes Control and Complications Trial Research Group; Nathan DM, Genuth S, Lachin J, 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 Sep 30;329(14):977-86.

  • Sherr JL, Schoelwer M, Dos Santos TJ, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes technologies: Insulin delivery. Pediatr Diabetes. 2022 Dec;23(8):1406-1431.

  • DiMeglio LA, Pottorff TM, Boyd SR, et al. A randomized, controlled study of insulin pump treatment in diabetic preschoolers. J Pediatr. 2004 Sep;145(3):380-4.

  • Wheeler BJ, Heels K, Donaghue KC, Reith DM, Ambler GR. Insulin pump associated adverse events in children and adolescents a prospective study. Diabetes Technol Ther. 2014;16(9):558-562.

  • Ly TT, Nicholas JA, Retterath A, et al. Effect of sensor augmented insulin pump treatment and automated insulin suspension vs standard insulin pump treatment on hypoglycemia in patients with type 1 diabetes: a randomized clinical trial. JAMA. 2013 Sep 25;310(12):1240-7.

  • Abraham MB, Nicholas JA, Smith GJ, et al. Reduction in Hypoglycemia With the Predictive Low Glucose Management System: A Long term Randomized Controlled Trial in Adolescents With Type 1 Diabetes. Diabetes care. 2018 Feb;41(2):303-10.

  • Weinzimer SA, Steil GM, Swan KL, et al. Fully automated closed loop insulin delivery versus semiautomated hybrid control in pediatric patients with type 1 diabetes using an artifi cial pancreas. Diabetes care. 2008 May;31(5):934-9.

  • Russell SJ, El-Khatib FH, Sinha M, et al. Outpatient glycemic control with a bionic pancreas in type 1 diabetes. N Engl J Med. 2014;371(4):313-25.

  • Annan SF, Higgins LA, Jelleryd E, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Nutritional management in children and adolescents with diabetes. Pediatr Diabetes. 2022 ;23(8):1297-1321.

  • Pastors JG, Waslaski J, Gunderson H. Diabetes meal planning strategies. In: Ross TA, Boucher J, O’Connell BS, eds. Diabetes Medical Nutrition Treatment and Training. Chicago: American Diabetes Association; 2005:201-217.

  • Chimen M, Kennedy A, Nirantharakumar K, et al. What are the health benefi ts of physical activity in type 1 diabetes mellitus? A literature review. Diabetologia. 2012;55(3):542-51.

  • Pivovarov JA, Taplin CE, Riddell MC. Current perspectives on physical activity and exercise for youth with diabetes. Pediatr Diabetes. 2015;16(4):242-55.

  • Maggio AB, Rizzoli RR, Marchand LM, et al. Physical activity increases bone mineral density in children with type 1 diabetes. Med Sci Sports Exerc. 2012 Jul;44(7):1206-11.

  • American Diabetes Association. 13. Children and Adolescents: Standards of Medical Care in Diabetes- 2019. Diabetes Care. 2019;42(Suppl 1):S148-S164.

  • Adolfsson P, Taplin CE, Zaharieva DP, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes. Pediatr Diabetes. 2022;23(8):1341-1372.

  • Limbert C, Tinti D, Malik F, et al. ISPAD Clinical Practice Consensus Guidelines 2022: The delivery of ambulatory diabetes care to children and adolescents with diabetes. Pediatr Diabetes. 2022;23(8):1243- 1269.

  • Workgroup on Hypoglycemia, American Diabetes Association. Defi ning and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care. 2005;28(5):1245-9.

  • Abraham MB, Karges B, Dovc K, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatr Diabetes. 2022;23(8):1322-1340.

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