Type 1 diabetes mellitus in childhood

Type 1 diabetes mellitus (T1DM) is the most common chronic metabolic condition in youth and its incidence is increasing worldwide. It must be differentiated from type 2 diabetes, which is also increasing in prevalence in parallel with the global rise in childhood obesity. T1DM presents initially with ketoacidosis (DKA) in 15–67% of cases. Glycaemic targets should be tailored to the child’s age and stage of development. With increasing age, given the proven benefit of tight metabolic control on the onset and progression of microvascular and macrovascular complications, glycaemic targets should be more stringent. Insulin regimens range from a variety of basal-bolus approaches to continuous subcutaneous insulin infusion (CSII). Self-monitoring of blood glucose (SMBG) is an essential component of management, as is attention to nutritional planning and physical activity. Care of the child and adolescent with T1DM should be multidisciplinary and involve professionals experienced in childhood diabetes, including a physician, nurse, dietitian and social worker. Maintenance of excellent glycaemic control and regular screening for complications should be emphasized, all in the context of a healthy and supportive physical and psychosocial environment.