Diabetes in the young: a paediatric and epidemiological perspective

Abstract

The spectrum of diabetes in the young has widened; it now includes monogenic diseases, for example the various forms of permanent and transient neonatal diabetes and MODY as well as the emerging obesityassociated Type 2 diabetes in late childhood, but the main form is still Type 1 diabetes. Age-related major medical, physiological, social and emotional problems make the clinical management of diabetes in children and adolescents a difficult task for the physician and the family. Overall glycaemic control remains moderate or poor despite a treatment schedule, which interferes with several elements of "normal" childhood.There is an up to tenfold geographical variation in the incidence of childhood Type 1 diabetes within Europe with relatively stable incidence rates in some countries (mainly northern), but dynamic increases in incidence in other countries (mainly central European).A number of nongenetic (environmental) factors have been associated with the risk of Type 1 diabetes.

Seasonality in clinical onset of Type 1 diabetes in Belgian patients above the age of 10 is restricted to HLA-DQ2/DQ8-negative males, which explains the male to female excess in incidence

“…It has been proposed that several external aetiological factors influence the incidence of Type 1 diabetes. These include viral infections, maternal blood group incompatibility, dietary toxins, early introduction of cows' milk, avoidance of breastfeeding, vitamin D deficiency, obesity, cold climate, puberty, pregnancy, rapid growth or weight gain, and psychological stress [6,8,15,29,30,31,32]. The diversity of these factors raises the question of whether they act through a limited number of common pathways.…”

“…The role of external factors is illustrated by the incomplete concordance rate (less than 50%) observed in monozygotic twins, by the geographical variation in incidence of Type 1 diabetes, and by the worldwide increase of the disease in young children [2,3,4,5,6,7]. Early introduction of cows' milk proteins, short duration of breastfeeding, rapid growth or weight gain, puberty, pregnancy, obesity, vitamin D deficiency, cold climate, psychological stress, maternal blood group incompatibility, dietary toxins and viral infections have all been proposed to initiate or promote diabetes, but none has emerged so far as the prime aetiological factor [2,6,7,8,9]. Several epidemiological studies have described a seasonal pattern in the onset of juvenile diabetes, with a peak incidence in winter and a nadir in the warmer summer months [10,11,12,13].…”

Socioeconomic conditions and type 1 diabetes in childhood in North Rhine–Westphalia, Germany

“…Current aetiological models propose gene-environment interactions, presuming that certain environmental exposures lead to the initiation of a T-cell-mediated autoimmune process in genetically susceptible individuals, which results in the destruction of the pancreatic islet cells [4]. External factors suggested to play a role in this autoimmune process are viral infections, pre-, peri-and postnatal influences, nutritional factors, psycho-social influences and stressful life events [4,5].…”

Protecting Pancreatic ß‐cells

“…Islets are dispersed throughout the pancreas representing less than 2% of the pancreatic tissue. Longlasting unstable glycemic control in patients with T1DM results in the development of microvascular, neuropathic and macrovascular complications that dramatically affect quality of life and life expectancy (1,2). Intensive insulin therapy aiming at tight glycemic control can significantly reduce or delay the risk of long-lasting diabetes complications but cannot sustain euglycemia throughout the day and may increase the frequency of severe hypoglycemic life-threatening episodes (1 -3).…”