Glycemic Control Goals In Pediatrics
As the DCCT only included pediatric patients aged 13 years , treatment guidelines for pediatric patients have been based nearly exclusively on professional, expert advice. Furthermore, despite the overall A1C goal of < 7% for adults with type 1 diabetes, pediatric patients, aged 1319 years, had an A1C target of < 7.5%. This slightly higher A1C target for adolescents with type 1 diabetes was based on expert recommendations and the clinical reality that optimizing glycemic control in adolescent patients with type 1 diabetes is especially challenging, given the physiological and behavioral challenges that confront this age-group.
The ADAs blood glucose and A1C goals traditionally have been developmentally or age based in the pediatric population, but it is now time to alter the traditional goals based on recent data. The traditional recommendations are an A1C goal of < 8.5% for youth under the age of 6 years, < 8% for those 612 years old, and < 7.5% for those 1319 years old. Lower blood glucose levels and lower A1C targets should be pursued as long as patients can avoid severe, recurrent hypoglycemia. Thus, the overall recommendation has included the goal to achieve as close to normal blood glucose and A1C levels as is possible without the occurrence of severe, recurrent hypoglycemia.
Studies assessing neurocognitive function have failed to identify adverse effects of a past history of hypoglycemia in the young child however, as always, further research needs to be conducted.
What Are Some Juvenile Diabetes Statistics
More commonly known as Type 1 diabetes, juvenile diabetes is typically diagnosed in children and is managed by daily insulin shots. Around 1.6 million Americans have Type 1 diabetes, including 200,000 youth, and there are approximately 64,000 new cases per year. According to JDRF, between 2001 and 2009, there was a 21% increase in Type 1 diabetes prevalence in people younger than 20.
Prediabetes Facts And Statistics
Prediabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. Prediabetes usually occurs in people whose bodies may not be able to effectively use the insulin they make or their pancreas may not produce enough insulin to keep their blood glucose levels in the normal range. People with prediabetes are at increased risk of developing type 2 diabetes. Learn more about prediabetes.
- An estimated 88 million adults ages 18 years or older have prediabetes. This includes
- nearly 29 million adults ages 18 to 44 years
- more than 35 million adults ages 45 to 64 years
- more than 24 million adults ages 65 or older (46.6 percent of U.S. adults in this age group
View the full report: National Diabetes Statistics Report, 2020 from the Centers for Disease Control and Prevention .
Type 1 Diabetes Facts
There is nothing anyone can do to prevent T1D. Presently, there is no known cure.
Type 1 diabetes is an autoimmune disease that occurs when a persons pancreas stops producing insulin, the hormone that controls blood-sugar levels. T1D develops when the insulin-producing pancreatic beta cells are mistakenly destroyed by the bodys immune system. The cause of this attack is still being researched, however scientists believe the cause may have genetic and environmental components.
Can Diabetes Be Prevented
People with diabetes risk factors are at greater risk of developing Type 2 diabetes, however, developing Type 2 diabetes is not inevitable.
Lifestyle modifications can lower your risk of developing Type 2 diabetes by almost 60%. These modifications include:
- Weight loss if you are overweight, losing 5% – 7% of your weight
- Physical activity getting 150 minutes of physical activity a week. That is just 30 minutes a day, five days a week
- Follow-up check with your primary physician for control of blood pressure and cholesterol
Also Check: How Many Carbs Should A Pre Diabetic Eat Per Day
Physical Activity And Exercise
Exercise has many positive health and psychological benefits including physical fitness, weight management, and enhanced insulin sensitivity. It also provides opportunities for social interactions and builds self-esteem. However, exercise creates challenges for people with type 1 diabetes due to the increased risk for both hypoglycemia and hyperglycemia. During exercise, multiple hormones control fuel metabolism and create a balance between glucose uptake by exercising muscles and hepatic glucose production . The equilibrium between insulin secretion and the counterregulatory hormones varies according to the exercise type, intensity, and duration .
Hyperglycemia results from counterregulatory hormone excess with insufficient insulin, leading to excessive hepatic glucose production and limiting increased glucose uptake into skeletal muscle. Hyperglycemia can occur before, during, and after various types of exercise. If the patient feels well, with negative or minimal urine and/or blood ketones, and there is a clear reason for the elevated blood glucose level, such as underdosing insulin at the preceding meal, it is not necessary to postpone exercise based solely on hyperglycemia. However, when people with type 1 diabetes are deprived of insulin for 1248 h and are ketotic, exercise can worsen hyperglycemia and ketosis. Therefore, vigorous activity should be avoided in the presence of severe hyperglycemia and ketosis, especially with known insulin omission.
How Do People Die From Diabetes
People rarely die from diabetes directly. Its more likely that someone with diabetes will die from complications with other organs. For example, high blood sugar can damage the kidneys over a long period of time, leading to potential kidney failure. And since diabetes is often associated with cardiovascular conditions, heart failure, and stroke are other common causes of death in diabetics. In rare cases of Type 1 diabetes, a condition called diabetic ketoacidosis can cause sudden death.
National Diabetes Statistics Report 2020
Data from this report can guide prevention and management efforts across the nation.
New diabetes cases have decreased over the last decade except in people younger than 20 years. And in adults, there is much room for improvement in preventing diabetes complications. Data from this report can help focus critical type 2 diabetes prevention and diabetes management efforts across the nation.
CDCs Division of Diabetes Translation has released the National Diabetes Statistics Report, 2020 pdf icon, which presents the state of the disease in the United States. The report provides the most recent scientific data on:
- New cases of diabetes
- Existing cases of diabetes
- Short- and long-term health complications
- Risk factors for health complications
- Death rate
The National Diabetes Statistics Report, 2020 pdf icon analyzed health data through 2018, providing statistics across ages, races, ethnicities, education levels, and regions. Data from this report provide vital perspectives on the current status of diabetes and can help focus prevention and management efforts going forward. New in 2020, the report features trends in prevalence and incidence estimates over time.
Key findings include:
Cause Of Rising Diabetes Incidence Unclear
These findings lead to many more questions, said Barbara Linder, M.D., Ph.D., senior advisor for childhood diabetes research at NIHs National Institute of Diabetes and Digestive and Kidney Diseases. The differences among racial and ethnic groups and between genders raise many questions. We need to understand why the increase in rates of diabetes development varies so greatly and is so concentrated in specific racial and ethnic groups.
Type 1 diabetes, the most common form of diabetes in young people, is a condition in which the body fails to make insulin. Causes of type 1 diabetes are still unknown. However, disease development is suspected to follow exposure of genetically predisposed people to an environmental trigger, stimulating an immune attack against the insulin-producing beta cells of the pancreas.
In type 2 diabetes, the body does not make or use insulin well. In the past, type 2 diabetes was extremely rare in youth, but it has become more common in recent years. Several NIH-funded studies are directly examining how to delay, prevent, and treat diabetes:
- Type 1 Diabetes TrialNet screens thousands of relatives of people with type 1 diabetes annually and conducts prevention studies with those at highest risk for the disease.
- For youth with type 2 diabetes, the ongoing Treatment Options for Type 2 Diabetes in Adolescents and Youth study is examining methods to treat the disease and prevent complications.
NIHTurning Discovery Into Health®
Glycemic Control Goals In Adults
Similar to in children, the care of older adults with diabetes is complicated by their clinical and functional heterogeneity. Unlike the large older adult population with type 2 diabetes, which includes patients with both long-standing and new-onset diabetes, most older adults with type 1 diabetes have long-standing disease. Even so, there is a wide spectrum of health across older individuals. They may have advanced complications, or they may have lived with diabetes for many years without the development of complications. Some older patients have multiple comorbid conditions and/or impairments of physical or cognitive functioning, while others have little comorbidity and high functional status. Life expectancy is highly variable and is defined by comorbidity and functional status more than it is by age.
Developing Countries: The Global Epidemic
Type 1 diabetes is an increasing global public health burden. The demands of daily management, chronicity of the disease, potential complications, paucity of diabetes specialists, and rising incidence are challenging in the U.S., but these issues, including the considerable cost of management, are crippling for those in the developing world. International organizations play a major role in improving care for individuals with type 1 diabetes in the developing world, but implementable, cost-saving, and sustainable strategies are needed to make such programs successful .
Type 1 Diabetes Statistics
Why look at statistics?
Rates of incidence of Type 1 diabetes are rising around the world. Statistics specific to certain countries allow us to study areas that may be experiencing a sharp uptick in Type 1 diagnoses, or even a gradual climb that indicates something is changing in that place. Looking at Type 1 through the lens of statistics also allows those of us living with diabetes every day to separate ourselves from something personal and emotional, focusing instead on facts and a bigger picture.
Diabetes: Facts Statistics And You
Diabetes mellitus is a term for a group of disorders that cause elevated blood sugar levels in the body.
Glucose is a critical source of energy for your:
When you eat, your body breaks down carbohydrates into glucose. This triggers the pancreas to release a hormone called insulin, which acts as a key that allows glucose to enter the cells from the blood.
If your body doesnt produce enough insulin to effectively manage glucose, it cant function or perform properly. This leads to symptoms of diabetes.
Diabetes thats not well managed can cause serious complications by damaging blood vessels and organs. It can increase the risk of:
Sensation Problems And Amputation
Diabetes causes mild loss of sensation in the extremities in as many as 70 percent of adults who have it. Amputations of lower extremities may eventually be necessary, especially for people with blood vessel disease. More than 60 percent of all nontraumatic amputations of lower limbs occur in people with diabetes. Approximately 73,000 lower-limb amputations were performed in diabetics age 20 and older.
Child Care And Schools
Because a large portion of a childs day may be spent in school and/or in the child care setting, close communication with and cooperation of the school or day care personnel is essential for optimal diabetes management, safety, and maximal academic opportunities. Child care personnel and school staff should receive training to provide diabetes care in the absence of a school nurse or licensed health care professional. Able and willing school staff members should be taught the principles of diabetes management and trained to provide needed care for the child according to the ADAs Safe at School program . Young children often lack the motor, cognitive, and communication skills and abilities to manage their diabetes and completely depend on adult caregivers. The management priority for younger children is the prevention, recognition, and treatment of hypoglycemia and marked hyperglycemia.
Students with diabetes should receive proper diabetes management in school, with as little disruption to the school and childs routine as possible. Whenever possible, the student should have the opportunity to self-manage by performing blood glucose monitoring, using CGM , administering insulin, having access to meals/snacks, managing hypoglycemia and hyperglycemia, and participating fully in all school-sponsored activities .
What Are The Symptoms Of Diabetes
Symptoms of Type 2 diabetes include:
- Increased thirst
- Weight loss, despite eating more than usual
- Having a family history of diabetes
- Having an African American, Hispanic/Latino American, American Indian, or Alaska Native racial or ethnic background
- Being physically active less than three times a week
- Having had gestational diabetes or giving birth to a baby who weighed more than nine pounds
- Having high blood pressure
Did You Know That Nearly 1 Million Ohio Adults Have Been Diagnosed With Diabetes
Diabetes is the 7th leading cause of death in Ohio and the United States . In 2016, diabetes was the primary cause of death for 3,500 Ohioans and was a contributing cause of many more deaths .
In 2016, nearly 1 million Ohio adults had been diagnosed with diabetes . In addition, nearly 800,000 adults in Ohio had been diagnosed with prediabetes, and it is estimated that more than 1 million Ohio adults have prediabetes but have not been diagnosed, increasing their risk of progressing to type 2 diabetes later in life .
As the Ohio Department of Health, we promote:
- Enhanced awareness of prediabetes and diabetes, including its complications, to all Ohioans
- Increased management of diabetes for those who have been diagnosed with diabetes
- Access to quality care for those disproportionately affected populations with prediabetes and diabetes
- Improved care of services for underserved populations with prediabetes and diabetes in Ohio
- Quality prediabetes and diabetes education, promoting wellness, physical activity, a healthy weight, blood pressure control, and smoking cessation
- Partnerships and community involvement to strive towards decreasing the prevalence of diabetes in Ohio
Us Prevalence In Young People
About 1.6 million Americans have type 1 diabetes, according to the American Diabetes Association .
Here is the number of people ages 19 and younger who have type 1 diabetes in each state, along with the prevalence rate, to put that number into better context. States are ranked in order of prevalence. Stats are from 2001 through 2016 , compiled by the CDC:
Dka And Type 1 Diabetes
Researchers in the paper above described how diabetic ketoacidosis , a life-threatening complication of type 1 diabetes, is present in 30 percent of young people with new onset-type 1 diabetes, according to the SEARCH for Diabetes in Youth Study. In addition, according to the Clinical Diabetes paper:
- DKA occurs more commonly when patients with type 1 diabetes are misdiagnosed .
- In the article’s retrospective online survey,25% of participants were misdiagnosed with another condition before receivingtheir type 1 diabetes diagnosis.
- That misdiagnosis/delay in the correct diagnosiswas associated with an 18% increased risk for DKA compared to those correctlydiagnosed.
- Misdiagnosis was correlated with increased ratesof DKA.
- DKA is the leading cause of death in childrenwith type 1 diabetes, and is associated with worse long-term outcomes.
- The rates of missed diagnosis rose when peoplegot older .
- About a quarter of first diagnoses of type 1diabetes in the U.K. happen in the presence of DKA, with similar results in theU.S., France and Poland, according to IDF’s 2019 Diabetes Atlas.
Additional Considerations For Pediatrics
All children require some level of adult supervision in managing their diabetes. Assessments of pediatric patients should address issues specific to infants/preschoolers, school-aged children, adolescents, and emerging adults . Health care providers should do a thorough assessment of the developmental needs of the youth , focusing on physical and emotional development, family issues, and psychosocial needs. The diabetes treatment plan should be individualized and tailored to the needs of individual patients and their families. Efforts to achieve target blood glucose and A1C levels should be balanced with preservation of quality of life and protect against excessive hypoglycemia.
Height and weight should be measured at each visit and tracked via appropriate height and weight growth charts. An age-adjusted BMI can be calculated starting at age 2 years. These tools can be found for children and teens at . Blood pressure measurements should be determined correctly, using the appropriate size cuff and with the child seated and relaxed. Hypertension should be confirmed on at least 3 separate days. Normal blood pressure levels for age, sex, and height and appropriate methods for determinations are available online at www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.pdf.
Type 1 Diabetes Treatment
People who have type 1 diabetes can live long, healthy lives. Youâll need to keep a close eye on your blood sugar levels. Your doctor will give you a range that the numbers should stay within. Adjust your insulin, food, and activities as necessary.
Everyone with type 1 diabetes needs to use insulin shots to control their blood sugar.
When your doctor talks about insulin, theyâll mention three main things:
- “Onset” is how long it takes to reach your bloodstream and begin lowering your blood sugar.
- “Peak time” is when insulin is doing the most work in terms of lowering your blood sugar.
- “Duration” is how long it keeps working after onset.
Several types of insulin are available.
- Rapid-acting starts to work in about 15 minutes. It peaks about 1 hour after you take it and continues to work for 2 to 4 hours.
- Regular or short-acting gets to work in about 30 minutes. It peaks between 2 and 3 hours and keeps working for 3 to 6 hours.
- Intermediate-acting wonât get into your bloodstream for 2 to 4 hours after your shot. It peaks from 4 to 12 hours and works for 12 to 18 hours.
- Long-acting takes several hours to get into your system and lasts about 24 hours.
Your doctor may start you out with two injections a day of two types of insulin. Later, you might need more shots.