Building Competency in Diabetes Education THE ESSENTIALS

4-6 | CHAPTER 4

During the past five years, there have been several advances in the diagnosis and treatment of diabetes in children which have had a significant impact in how we manage this age group. Research in the areas of genetics and continuous glucose monitoring (CGM) have been particularly relevant to pediatrics. The diagnosis of atypical diabetes referring specifically to the multiple forms of monogenic diabetes has led to different treatment modalities. The advancement of CGM to detect and act on low blood glucose (BG) and having an ‘auto mode’ available with continuous subcutaneous insulin infusion (CSII) has led to consideration of lower blood glucose targets for children. The use of newer medications, specifically SGLT2 inhibitors and GLP-1 medications, in adolescents has also been a change in practice (4). Differential diagnosis for children with diabetes It is often difficult to distinguish the actual type of diabetes a child or adolescent may be presenting with. However, due to the different approaches to treatment, it is important to identify whether the child has type 1, type 2 or monogenic diabetes. In adults, the presence of autoimmune antibodies, i.e. GAD, and the presence of insulin autoantibodies are most often associated with type 1 diabetes. Diabetic ketoacidosis (DKA) usually relates to type 1 diabetes, while hyperosmolar hyperglycemic state (HHS) relates to type 2 diabetes. Typically, an obese child who develops diabetes is assumed to have type 2 diabetes. However, these markers and others used to distinguish type 1 from type 2 diabetes are not as reliable or as absolute as previously thought. To add a further complication to the diagnosis, monogenic diabetes has been recognized with several subcategories, including neonatal diabetes and MODY (maturity onset diabetes in youth) (4,10).

Figure 3. Diagnostic features of diabetes

•autoimmune •total insulin deficiency •requires insulin replacement

Type 1

•autosomal-dominant form of diabetes

Monogenic

•insulin resistance •decreased insulin secretion

Type 2