Pediatric Diabetes: Early Symptoms and Effective Treatment

What is pediatric diabetes?

Diabetes mellitus in children and adolescents is a chronic condition that is becoming increasingly prevalent worldwide [6]. It can manifest in two main forms: type 1 diabetes mellitus (T1D) and type 2 diabetes mellitus (T2D). T1D is an autoimmune disease in which the body destroys the insulin-producing cells of the pancreas. In pediatric practice, T1D is significantly more common, accounting for approximately 92.8% of all diabetes cases in children [5].

T2D, once considered an adult disease, is now increasingly diagnosed in adolescents due to the global obesity pandemic [3, 6, 8]. It is important to timely and accurately differentiate between these two types of diabetes, as this directly affects the choice of optimal treatment, prognosis of complications, and assessment of health risks for the child [6].

Main symptoms of type 1 diabetes in children

T1D typically debuts in childhood and adolescence with characteristic signs. These include:

• Polyuria (frequent urination) [1]
• Polydipsia (increased thirst) [1]
• Weight loss, despite normal or increased food intake [1]

In some cases, the disease can manifest more acutely, progressing to diabetic ketoacidosis (DKA), which requires immediate medical attention. Symptoms of DKA include abdominal pain, vomiting, and characteristic deep, labored breathing (Kussmaul breathing) [1].

Sometimes T1D can present less typically. For example, in one case, a 17-year-old adolescent presented with fatigue and bilateral blurred vision caused by cataracts as initial symptoms, which were detected prior to planned cataract surgery [1].

In addition to physical manifestations, children and adolescents with T1D often experience psychological issues. A systematic review showed that symptoms of depression and anxiety are prevalent among this group, reaching 30.04% of cases, and correlate with the level of glycemic control [2]. Therefore, screening for psychosocial risk factors is recommended from the time of diagnosis [2].

Features of type 2 diabetes and prediabetes in adolescents

Type 2 diabetes in adolescents is closely linked to the epidemic of childhood obesity [3, 6, 8]. At the onset of T2D, adolescents may also experience polydipsia (45.8%) and polyuria (33.3%) [3]. However, unlike T1D, other signs associated with metabolic disorders are often present:

• Acanthosis nigricans (darkening and thickening of the skin in folds) [3]
• Hypertension (high blood pressure) [3]
• Dyslipidemia (lipid metabolism disorder) [3]

The average glycated hemoglobin (HbA1c) level at the time of T2D diagnosis in adolescents can be significantly elevated, averaging 9.9% [3].

Prediabetes in children and adolescents is also a growing problem driven by childhood obesity. This condition is characterized by impaired glucose metabolism and is associated with an increased risk of cardiovascular diseases, such as dyslipidemia, hypertension, metabolic dysfunction-associated steatotic liver disease, and sleep disorders [8]. Insulin resistance, which physiologically decreases during puberty and can exacerbate the course of the disease, plays a key role in the pathogenesis of these conditions [8].

Diagnosis and modern treatment approaches

Early diagnosis and adequate treatment are crucial for preventing complications and improving the quality of life of children with diabetes. Differentiation between T1D and T2D is essential for choosing the correct therapeutic strategy [6].

Modern treatment methods include:

• Continuous Glucose Monitoring (CGM): This method has proven effective in T1D and shows a positive impact on glycemic control, patient satisfaction, and disease management in adolescents with T2D, although data on this group remain limited [3].
• Lifestyle Modification: For children and adolescents with prediabetes and T2D, lifestyle modification, including diet and physical activity, remains the primary intervention method [8].
• Pharmacological Treatment: Depending on the type of diabetes and the patient's individual needs, insulin therapy (in T1D and sometimes T2D) or other glucose-lowering medications are prescribed.

New treatment methods are constantly being developed to achieve optimal glycemic control, limit weight gain, improve quality of life, and reduce comorbidities [6]. Screening for psychosocial risk factors from the time of diagnosis is also recommended [2].

Impact of diabetes on quality of life and comorbidities

Diabetes mellitus has a significant negative impact on various aspects of the quality of life of children and adolescents [5]. Poor glycemic control, which is observed in the majority of patients (in one study, 92.3% of participants) [5], increases the risk of acute and chronic complications.

Children and adolescents with T1D often experience comorbid autoimmune and metabolic diseases that can negatively affect long-term health outcomes [4]. In rare cases, diabetes may be part of a more complex genetic syndrome, such as Wolfram syndrome. In this syndrome, non-autoimmune diabetes is typically the first clinical sign, followed by optic atrophy, sensorineural hearing loss, and diabetes insipidus [7]. The prognosis for Wolfram syndrome is unfavorable, with death occurring on average at age 39 due to progressive respiratory failure associated with brain atrophy [7]. A multidisciplinary approach to treatment is necessary for such patients, as metabolic control of diabetes correlates with the onset of other symptoms and the progression of neurodegenerative changes [7].

Even after successful treatment, such as cataract removal, patients with diabetes may develop complications such as pseudophakic cystoid macular edema [1]. This emphasizes the need for continuous monitoring and a comprehensive approach to managing children with diabetes.

Sources

1. Cataracts as an initial symptom of type 1 diabetes mellitus. https://pubmed.ncbi.nlm.nih.gov/42027589/
2. Depressive and anxiety symptoms in adolescents with type 1 diabetes mellitus: a systematic review and meta-analysis. https://pubmed.ncbi.nlm.nih.gov/27179232/
3. Young people with type 2 diabetes mellitus: clinical data at onset and the impact of continuous glucose monitoring (CGM) on glycemic control and disease management. https://pubmed.ncbi.nlm.nih.gov/42638350/
4. Clinical characteristics and comorbidities in children and adolescents with type 1 diabetes mellitus: a retrospective study. https://pubmed.ncbi.nlm.nih.gov/42326259/
5. Disease-specific quality of life and related health outcomes in children with diabetes in Khartoum State, Sudan: a cross-sectional study. https://pubmed.ncbi.nlm.nih.gov/42481550/
6. The changing face of pediatric diabetes. https://pubmed.ncbi.nlm.nih.gov/31897525/
7. Metabolic treatment of Wolfram syndrome. https://pubmed.ncbi.nlm.nih.gov/35270448/
8. Prediabetes in children and adolescents: what do we need to know? https://pubmed.ncbi.nlm.nih.gov/42415555/

The information provided in the article is for informational purposes only and does not replace the consultation of a qualified medical specialist. Always consult a physician for diagnosis and treatment.