Diabetes mellitus is the second most common chronic disease of childhood, and one of the leading causes of blindness and renal failure in developed nations. The scope and treatment of diabetes is changing for children, providing challenges in at least three major areas.
The first is the increasing prevalence of type II diabetes mellitus, especially among minority populations. As pediatricians, we need to develop an increased awareness of this disease and public health programs designed to reduce the incidence of type II diabetes mellitus. We also need to evaluate the treatment of type II diabetes mellitus in children and determine the best methods by which to sustain weight loss, as well as the efficacy and side effects of drugs to improve insulin sensitivity.
The second challenge arises from the findings of the Diabetes Control and Complication Trial (DCCT). The DCCT has shown that improved glycémie control reduces the risk of long-term microvascular complications, but with an increased risk of hypoglycemia and obesity. We need to determine which patients will benefit the most from intensive insulin therapy, and at what age to implement strict glycémie control. Designer insulins such as lyspro (ultrashort acting) insulin are already being used for children, and pediatricians must become familiar with them. Insulin pump treatment is also being used by adolescents and school-age children. Pediatricians must learn to identify the patients who might benefit from pump therapy and determine the optimal age at which to transition them to a center with expertise in pump management. Finally, bloodless glucose monitoring is about to enter widespread clinical use. Pediatricians need to determine the accuracy of these devices in children and the optimal age at which to begin cutaneous monitoring.
The third challenge will be to incorporate increased understanding of the pathogenesis and genetics of diabetes mellitus into the early diagnosis and prevention of this disease. This is an era full of excitement and challenge for the care of children with diabetes mellitus. Our hope is that the discussions provided by the authors of this issue will help pediatricians focus on key problems that must be addressed to improve the future of children with diabetes mellitus.