Childhood or youth diabetes is a disease that typically affects children and teenagers. It is also called ‘insulin-dependent’, since treatment with subcutaneous insulin is necessary for the rest of their lives. Nowadays, from the conceptual point of view, Type 1 Diabetes (DM 1) is caused by the destruction of the pancreatic cells that produce insulin.
According to approximate figures, there are 29,000 children suffering from diabetes in Spain and 1,100 new cases are diagnosed every year. Figures related to age show that the incidence is of 11.3 people from 0 to 15 years of age in 100,000 inhabitants and 9.9 people from 15 to 29 years of age in 100,000 inhabitants. Carlos J. Ruiz Cosano, a teacher from the Department of Paediatrics at the University of Granada, states that “diabetes is one of the most frequent endocrine diseases in infancy“.
According to the World Health Organisation (WHO), diabetes is one of the objective diseases for which health programs based on early diagnosis, treatment and prevention in risk groups are developed. The WHO considers that in the year 2000 there were 171 million diabetic people in the world and they predict a figure of 366 million diabetic people by 2030. The figures provided by the WHO for 2030 will mean more than 3 million diabetic people in Spain.
Genetic features
According to experts, there are several factors that can contribute to the development of diabetes, and the first of these factors is the genetic feature of the disease, since there is an obvious family association. To that effect, according to Carlos J. Ruiz, “the probability of the development of diabetes in a child if his parents are diabetic is around 30 %. Moreover, 20 chromosomal regions have been described and their disease can contribute to the genetic predisposition to suffer from diabetes”. Secondly, experts have also identified an immune mechanism in the disease development. This is an autoimmune mechanism and, therefore, in predisposed people “the disease can develop after the existence of a factor that triggers it (infections, toxic processes and so on), autoantigens, i.e. elements produced by the organism and that are not identified by it. However, in the case of DM 1 these autoantigens cause the destruction of the pancreatic cells that produce insulin”.
Obesity
However, DM 1 is a disease caused by various factors, so along with these mechanisms it is known that there are certain diseases which can coincide with diabetes. Child obesity is the most important among them. Therefore, in studies that include a wide range of obese children, experts have noted a greater incidence of diabetes in these children. Carlos J. Ruiz states that the concept of “Metabolic Syndrome” has been redefined and, nowadays, there is a greater risk of suffering from cardiovascular diseases and Diabetes Mellitus Type 2 (or adult diabetes), both related to previous obesity and resistance to action of insulin. In this respect, “a greater incidence of Diabetes Mellitus Type 2 is being described in epidemiology studies of obese children and teenagers who also suffer from irregularities in terms of fatty acids such as hypertrigliceridemy and even hypertension”.
Diabetological education
In view of this situation, Carlos J. Ruiz states that it is fundamental to ensure both early diagnosis in risk groups such as children whose parents are diabetic and development of health programs about the treatment and prevention of diabetes, hypercholesterolemy and hypertension in teenagers and, increasingly, in children. This is because “we cannot forget the relation between these diseases and the subsequent development of diabetes in those children when older”. Consequently, “the fight against obesity and bad eating habits must have top priority in terms of public health objectives all of the paediatric population”.
With regard to treatment, Carlos Ruiz insists on the importance of the basic diagram of four pillars: insulin, exercise, diet and family. “In the absence of one these factors, the treatment of a diabetic child is heading for failure”. Nevertheless, with specific reference to the insulin treatment, there are new prospects such as prolonged-action insulin, continuous insulin pump therapy and others that are being studied such as stem cell therapy; “although their current application in a hospital is not possible”. For this reason, from the point of view of current treatment, Carlos J. Ruiz emphasizes the importance of “diabetological education, active participation of the family and trust in the family paediatrician”.
Reference:
Prof. Carlos J. Ruiz Cosano. Department of Pediatrics of the Universidad de Granada.
Telephone Numbers: 958 240 740 / 240 745. Email address: cruiz@ugr.es
