ABSTRACT
Achieving normal or near-normal glycemic control as reflected by HbA1c levels in patients with type 1 diabetes (T1D) is important for preventing the development and progression of chronic complications. Despite delineation and dissemination of HbA1c management targets and advances in insulin pharmacology, insulin delivery systems, and glucose monitoring, the majority of children with T1D do not achieve HbA1c goals. In particular, African Americans are more likely not to reach HbA1c goals and have persistently higher HbA1c than Non-Hispanic Whites. Availability of pumps and other technology has not eliminated the disparity in HbA1c. Multiple factors play a role in the persisting racial disparity in HbA1c outcome. The carefully designed application and deployment of new technology to help the patient/family and facilitate the supportive role of the diabetes management team may be able to overcome racial disparity in glycemic outcome and improve patient quality of life.
Subject(s)
Blood Glucose Self-Monitoring/instrumentation , Diabetes Mellitus, Type 1 , Healthcare Disparities , Adolescent , Black or African American , Blood Glucose , Child , Diabetes Mellitus, Type 1/drug therapy , Glycated Hemoglobin/analysis , Humans , Quality of Life , TechnologySubject(s)
Candidiasis/diagnosis , Diabetes Mellitus, Type 1/diagnosis , Ileal Diseases/diagnosis , Ileal Diseases/surgery , Intestinal Perforation/diagnosis , Intestinal Perforation/surgery , Multiple Organ Failure/diagnosis , Child, Preschool , Diagnosis, Differential , Female , Humans , Ileal Diseases/microbiology , Intestinal Perforation/microbiology , Multiple Organ Failure/microbiology , NecrosisABSTRACT
Type 2 diabetes mellitus (T2DM) is a chronic progressive disease with high morbidity and mortality rates. Previously an adult onset disease, it is now being diagnosed more and more in childhood and adolescence. Lately, Asia has become the epicenter of this epidemic. Childhood T2DM is a new challenge for the pediatrician. Due to similarities in presentation, children may initially be misdiagnosed with Type 1 diabetes mellitus (T1DM). Most oral anti-diabetic agents have not been approved for use in adolescents, and there is a concern for safety of their use. Lifestyle intervention is difficult to conduct, and adherence to recommendations is lower in adolescents than in adults with T2DM. Higher incidence and early onset of co-morbidities, with lack of long term outcomes data make the management problematic. In many communities, due to a shortage of specialists, general practitioners will treat children with T2DM. Guidelines cited in this review are designed to help with the diagnostic process and management.
