Diabetes Mellitus

The incidence of diabetes among children and adolescents is, in most cases, Type 1 diabetes. However, alongside the rise in obesity rates among children and adolescents, an increase in Type 2 diabetes cases is also being observed. According to data from the Diabetes Registry of the National Center for Disease Control (NCDC), the incidence of Type 1 diabetes among children and adolescents (ages 0–17) rose from 8 cases per 100,000 in 1997 to 13.8 cases per 100,000 in 2015.In that year, 382 new cases of Type 1 diabetes were diagnosed among individuals aged 0–17 (1).

Diabetes in children and adolescents involves unique challenges, such as changing insulin needs during growth and puberty, irregular eating and physical activity patterns, limited self-care ability, and the need for family and school support. To meet these specific needs, the American Diabetes Association (ADA) recommends that treatment for children and adolescents be provided in dedicated, multidisciplinary diabetes clinics. These clinics should address not only medical care, but also self-management education, nutrition, and emotional and psychological support for both the child and family. Optimal blood glucose control is essential to prevent both short-term complications (hyperglycemia, diabetic ketoacidosis, and hypoglycemia) and long-term complications, including microvascular and macrovascular damage, which can lead to cardiovascular disease, blindness, peripheral nerve damage, and kidney failure. Blood glucose is monitored both daily through self-testing and periodically through the HbA1c (glycated hemoglobin) test, which reflects average blood glucose levels over the past three months. As with adults, maintaining a balance between achieving near-normal blood glucose levels and minimizing the risk of hypoglycemia is crucial in children. According to ADA guidelines, an HbA1c level of 7.5% or lower indicates good diabetes control in patients under 18, while a level above 9% indicates poorly controlled diabetes. (2)

Like adults with diabetes, children with diabetes are at higher risk for flu and its complications. The Ministry of Health recommends annual flu vaccination for everyone over 6 months old, with particular importance for those with chronic conditions, including children with diabetes. (3)

Notes: Due to the complexity of monitoring and treating diabetes in children and adolescents, it is recommended that care be provided by multidisciplinary teams within specialized diabetes clinics. The indicator measuring the proportion of visits to pediatric diabetes clinics (in the community or hospitals) encompasses most diabetes care quality measures. This is based on the assumption that these clinics provide comprehensive and optimal treatment and monitoring, making them a “black box” for assessing the quality of care.