Rising incidence and challenges of childhood diabetes. A mini review

Abstract

Approximately 215,000 people younger than 20 yr of age, or 1 in 500 children and adolescents, had diabetes in the United States in 2010--and the incidence is rising. We still have insufficient knowledge about the precise mechanisms leading to the autoimmune mediated β-cell destruction in Type 1 diabetes, and the β-cell failure associated with insulin resistance in Type 2 diabetes. Long-term complications are similar: micro- and macrovascular disease occurs prematurely and presents an enormous burden on affected individuals, often as early as in middle age. In Type 1 diabetes, technological advances have clearly improved blood glucose management, but chronic peripheral over-insulinization remains a problem even with the most advanced systems. Thus, in Type 1 diabetes our research must focus on 1) finding the stimulus that ignites the immune response and 2) developing treatments that avoid hyperinsulinemia. In Type 2 diabetes in youth, the challenges start much earlier: most young patients do not even benefit from existing therapies due to non-compliance. Therefore, prevention of Type 2 diabetes and improvement of compliance, especially with non-pharmacological interventions, are the greatest challenges.

Fig. 1

Rate of new cases of Type 1 and Type 2 diabetes among children, adolescents, and young adults <20 yr of age, by race/ethnicity, between 2002 and 2005. NHW: non-Hispanic whites; NHB: non-Hispanic blacks; H: Hispanics/Latinos; API: Asian/Pacific Islander Americans; Al: American Indians. Source: SEARCH for Diabetes in Youth Study (diabetes.niddk.nih.gov/dm/pubs/statistics/images/DMStats2011-Chart3.jpg&imgrefurl=http).

Fig. 2

Genetic predisposition and a combination of obesity and β-cell failure lead to Type 2 diabetes. Several epigenetic and environmental factors contribute to both, weight gain and loss of β-cell function. Purple arrows indicate the contribution to obesity, green arrows to β-cell failure. The appropriate references can be found in the text.