Issues in Diagnosis and Treatment of Type 1 Diabetes Mellitus in Childhood

Type 1 Diabetes Mellitus remains one of the most complex chronic diseases in childhood. Although advances in knowledge and technology, as the use of insulin pumps or glucose sensors, have improved the quality of life of patients, the onset of the disease, as well as long-term treatment and diet, are pitfalls for families and clinicians. It is important to bear in mind that acute, life-threatening consequences of uncontrolled diabetes are hyperglycemia with ketoacidosis, both in new diagnosis and in patients already on treatment, and may be hidden by other symptoms. Moreover, treatment with insulin and diet should always be tailored on lifestyle habits and age of the patient. Aim of this work is to briefly summarise and comment what are the worst insidious aspects of Diabetes and what are the best strategies to improve the management of the disease in childhood.

[1]  H. Chase,et al.  Prediction of Type I Diabetes in First-Degree Relatives Using a Combination of Insulin, GAD, and ICA512bdc/IA-2 Autoantibodies , 1996, Diabetes.

[2]  R. Abbott,et al.  Hyponatremia: evaluating the correction factor for hyperglycemia. , 1999, The American journal of medicine.

[3]  E. Böber,et al.  Partial Remission Phase and Metabolic Control in Type 1 Diabetes Mellitus in Children and Adolescents , 2001, Journal of pediatric endocrinology & metabolism : JPEM.

[4]  J. Krischer,et al.  Effects of oral insulin in relatives of patients with type 1 diabetes: The Diabetes Prevention Trial--Type 1. , 2005, Diabetes care.

[5]  J. Ilonen,et al.  Genetic, autoimmune, and clinical characteristics of childhood- and adult-onset type 1 diabetes. , 2000, Diabetes care.

[6]  J. Wolfsdorf,et al.  Diabetic Ketoacidosis in Infants, Children, and Adolescents , 2006, Diabetes Care.

[7]  J. McGarry,et al.  The metabolic derangements and treatment of diabetic ketoacidosis. , 1983, The New England journal of medicine.

[8]  J. Wolfsdorf,et al.  Diabetic Ketoacidosis in Infants, Children, and Adolescents , 2006, Diabetes Care.

[9]  G. Werther,et al.  The accuracy of clinical assessment of dehydration during diabetic ketoacidosis in childhood. , 2004, Diabetes care.

[10]  C. Beaufort Variation and trends in incidence of childhood diabetes in Europe , 2000, The Lancet.

[11]  J. Assal,et al.  Metabolic Effects of Sodium Bicarbonate in Management of Diabetic Ketoacidosis , 1974, Diabetes.

[12]  M. Yang,et al.  Cerebral edema in childhood diabetic ketoacidosis: natural history, radiographic findings, and early identification. , 2004, Diabetes care.

[13]  A. Kitabchi,et al.  Low-dose insulin therapy in diabetic ketoacidosis: fact or fiction? , 1989, Diabetes/metabolism reviews.

[14]  A. Kitabchi,et al.  Hyperglycemic Crises in Adult Patients With Diabetes , 2006, Diabetes Care.

[15]  Thomas Danne,et al.  Insulin treatment in children and adolescents with diabetes , 2009, Pediatric diabetes.

[16]  I. Fiordalisi,et al.  Physiologic management of diabetic ketoacidemia. A 5-year prospective pediatric experience in 231 episodes. , 1994, Archives of pediatrics & adolescent medicine.

[17]  E. Majaliwa,et al.  Type 1 diabetes mellitus in the African population: epidemiology and management challenges. , 2009, Acta bio-medica : Atenei Parmensis.

[18]  M. Bennett,et al.  Potassium balance during treatment of diabetic ketoacidosis with special reference to the use of bicarbonate. , 1972, Lancet.

[19]  M. Katz Hyperglycemia-induced hyponatremia--calculation of expected serum sodium depression. , 1973, The New England journal of medicine.

[20]  H. Chase,et al.  Diabetic ketoacidosis in children and the role of outpatient management. , 1990, Pediatrics in review.

[21]  P. Bingley,et al.  Combined use of autoantibodies (IA-2 autoantibody, GAD autoantibody, insulin autoantibody, cytoplasmic islet cell antibodies) in type 1 diabetes: Combinatorial Islet Autoantibody Workshop. , 1998, Diabetes.

[22]  K. Kulkarni,et al.  Using carbohydrate counting in diabetes clinical practice. , 1998, Journal of the American Dietetic Association.

[23]  G. d’Annunzio,et al.  Age-Period-Cohort Analysis of 1990–2003 Incidence Time Trends of Childhood Diabetes in Italy , 2010, Diabetes.

[24]  R. DeFronzo,et al.  Effect of graded doses of insulin on splanchnic and peripheral potassium metabolism in man. , 1980, The American journal of physiology.

[25]  Heather J Cordell,et al.  Absolute risk of childhood-onset type 1 diabetes defined by human leukocyte antigen class II genotype: a population-based study in the United Kingdom. , 2004, The Journal of clinical endocrinology and metabolism.

[26]  G. Eknoyan,et al.  Determinants of Plasma Potassium Levels in Diabetic Ketoacidosis , 1986, Medicine.

[27]  R. Hanås,et al.  A 2‐yr national population study of pediatric ketoacidosis in Sweden: predisposing conditions and insulin pump use , 2009, Pediatric diabetes.

[28]  J. Edge Cerebral oedema during treatment of diabetic ketoacidosis: are we any nearer finding a cause? , 2000, Diabetes/metabolism research and reviews.

[29]  D. Dunger,et al.  The UK case–control study of cerebral oedema complicating diabetic ketoacidosis in children , 2006, Diabetologia.

[30]  J. Cohen,et al.  Bicarbonate therapy for organic acidosis: the case for its continued use. , 1987, Annals of internal medicine.

[31]  D. Dunger,et al.  Diabetic ketoacidosis in children and adolescents with diabetes , 2009, Pediatric diabetes.

[32]  J. Todd,et al.  HLA DR-DQ Haplotypes and Genotypes and Type 1 Diabetes Risk , 2008, Diabetes.

[33]  C. Acerini,et al.  Nutritional management in children and adolescents with diabetes , 2014 .

[34]  N. Morgan,et al.  The prevalence of enteroviral capsid protein vp1 immunostaining in pancreatic islets in human type 1 diabetes , 2009, Diabetologia.