Building Competency in Diabetes Education THE ESSENTIALS

4-10 | CHAPTER 4

Table 1: Clinical characteristics of type 1 diabetes, type 2 diabetes and monogenic diabetes in children and adolescents (4) Characteristics Type 1 Type 2 Monogenic Genetics Polygenic Polygenic Monogenic Age of onset >6–12 months Usually pubertal (or later) Often post

pubertal except glucokinase and neonatal diabetes Variable (may be incidental in glucokinase)

Clinical presentation

Most often acute, rapid

Variable; from slow, mild (often insidious) to severe

Autoimmunity

Yes

No

No

Ketosis

Common

Uncommon

Common in neonatal diabetes, rare in other forms

Obesity

Population frequency

Increased frequency

Population frequency

Acanthosis nigricans

No

Yes

No

Frequency (% of all diabetes in young people)

Usually 90% +

Most countries <10% (Japan 60-80%)

1-6%

Parent with diabetes

2-4%

80%

90% +

Adapted from ISPAD 2018 (4)

Although the diagnostic criteria and medical treatment for type 1, type 2 and monogenic diabetes in children is different, there are many similar concerns regarding behaviour, adjustment to diagnosis and parental involvement which will be addressed in the following discussion. For a more in-depth review regarding screening and medical treatment in this age group, please refer to the pediatric chapters in the 2018 Guidelines: Type 1 Diabetes in Children and Adolescents (8); Type 2 Diabetes in Children and Adolescents (2) and to the International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines 2018 (4).