Diabetes in Youth

31 March 2023

Worldwide, the number of children, adolescents and young adults living with diabetes is increasing rapidly [1]. Type 1 diabetes (T1D) is the most common form of youth-onset diabetes, and the Europe Region has the highest number of children and adolescents living with the condition (295,000) as well as the highest incidence annually (31,000). Although type 2 diabetes (T2D) is far less common than T1D in childhood, an increasing trend in its prevalence in the paediatric population has been recorded over the past 30 years, with the highest rates reported in the United States [2].

T1D is characterised by an autoimmune reaction whereby the body’s defence system attacks the cells that produce insulin [3]. Genetic susceptibility and environmental factors play a role in the development of T1D, although how is still unclear [4].

T2D is most commonly diagnosed in older adults, and it is generally characterized by insulin resistance, where the body does not fully respond to insulin [5]. The rapid increase in T2D in youth over the last two decades is particularly worrisome as the development of the disease tends to be quicker and more severe compared to youths with T1D or adults with T2D, leading to a higher and accelerated risk of developing diabetes-related complications [26]. T2D in children results from complex interactions between social, behavioural and environmental factors that affect genetically-susceptible individuals. Some of the key risk factors include: race and ethnicity; obesity, diet, low levels of physical activity and sedentary lifestyle; age, sex and puberty, with higher incidence and prevalence in girls than boys; family history and genetics, with studies showing that more than half of youths with T2D have at least one parent living with diabetes; or early life determinants such as nutrition, gestational diabetes and maternal obesity [26].

Young PwD require special attention and care for managing the condition as they experience the burden of living with a chronic disease during a critical developmental phase of their lives characterised by biological, psychosocial and cognitive changes [7]. For this reason, multidisciplinary diabetes teams comprised of specialists with expertise in both diabetes and paediatrics are crucial for supporting young PwD in all aspects of diabetes management [8].

Monitoring and supporting mental health in young PwD is also of the utmost importance. Chronic conditions such as diabetes can in fact often exacerbate stress in children and adolescents as they go through challenging developmental stages in their lives. In turn, high levels of distress can generate barriers to optimal diabetes management and self-care. It is estimated that one in three adolescents with T1D (aged 10-20 years), one in three adolescents and young adults with T2D (aged 13-21 years) and up to 60% of young adults (aged 18-30 years) report elevated diabetes distress, with prevalence rates for depression among young PwD ranging from 17% to 63%. Studies have also found that children and adolescents with diabetes have increased rates of eating disorders rates compared to those without diabetes. Given the critical influence of mental health on PwD self-management, psychological assessment and support should always be incorporated in diabetes care [9].

With nutrition and physical activity being cornerstones of diabetes management, young PwD should also have access to paediatric specialist diabetes dietitians, and exercise should be discussed as part of their routine diabetes care. In this context, nutritional care should take into consideration important contextual factors such as the role of the family and the community in which young PwD live, their traditions and socioeconomic status. Similarly, advice on physical activity should address some potential disease-specific barriers such as fear of hypoglycaemia, issues around body image and parental hesitancy which often lead to high rates of sedentary behaviours in youth with diabetes [1011].

Diabetes education can play a key role in empowering PwD and their families by guiding them through the complexity of the condition and the numerous daily decisions they need to take. Diabetes education should be delivered by the multidisciplinary diabetes team at the time of diagnosis and throughout the life course in a personalized manner, with particular attention to the individual’s age, stage of diabetes, maturity and lifestyle, culture and learning pace. Structured diabetes education should not only be accessible to PwD, but also to their community including their families, carers, teachers and peers [12].

Access to the appropriate technology for blood glucose monitoring and insulin delivery for young PwD can play a key role in helping them and their families managing the condition. For example, continuous glucose monitoring systems (CGM) can significantly alleviate diabetes distress, worries and hypoglycaemia, and subsequently improve general well-being [13]. Similarly, the use of insulin pumps can increase young PwD autonomy in diabetes management and decrease diabetes burden [14].

Given the recent trends in the rising number of children, adolescents and young adults developing diabetes, more research needs to be done to better understand this complex and evolving condition. At the same time, we should ensure that, based on the current evidence on diabetes management and care in youth, all young PwD and their families have access to the support they need for achieving the best possible health outcomes and quality of life.