ISPAD/IDF PERSPECTIVES ON CHILDHOOD
AND ADOLESCENT DIABETES
Silink M
The Children’s Hospital at Westmead, Sydney, Australia
Diabetes is an evolving disease with rises seen in both type 1
and type 2 diabetes. A wide (over 400 fold) variation exists in incidence
rates of type 1 diabetes with the highest occurring in Finland (over 45 per
100,000 under the age of 15 years) and the lowest in parts of China (1).
International guidelines for the treatment of type 1 diabetes have been
developed by the International Society for Pediatric and Adolescent
Diabetes (ISPAD). In many developing countries escalating costs of insulin
and monitoring exceed the family’s ability to provide for their child’s
treatment. The International Diabetes Federation (IDF) is addressing this
problem by launching a Child Sponsorship - Life for a child with diabetes -
program.
The IDF is concerned at the global increase in Type 2 diabetes, including in
adolescence and childhood. In
Japan the incidence of type 2 diabetes in adolescents is four times that
for type 1. In the USA, one third of newly diagnosed adolescents with
diabetes have type 2 (2). Many ethnic indigenous populations are at special
risk for type 2 diabetes, but the rise is being seen in many other
populations. Insulin resistance can be demonstrated in even non-obese
children born to parents with type 2 diabetes (4,5). The microvascular
complications of type 2 diabetes are severe and occur as rapidly as those
in type 1 diabetes. Management of type 2 diabetes is especially difficult
in adolescents.
Obesity is the single-most obvious risk factor for type 2
diabetes (but in certain populations up to 25% are non-obese). Life-style
modification programs starting in childhood are urgently needed and society
needs to change its attitudes to nutrition, smoking, and exercise.
Collaborations between IDF, WHO, ISPAD, international cardiovascular,
hypertension and obesity societies are looking at integrated data
collection, standardized screening methods and approaches to governments.
1. Ze Yang et al.
Diabetes Care 21:525-529, 1998 4. Gulli G et al. RA Diabetes 41:1575-86, 1992
2. Pinhas-Hamiel. J Pediatr
1996;128:608-15 5.
Arslanian S. J Pediatr 1996;129:440-3
3. Mokdad AH et al. Diabetes Care 23:1278-81,
2000