The increasing onset of type 1 diabetes in children.

OBJECTIVE: To identify trends in the recent onset of type 1 diabetes (T1D) in Colorado youth seen at the Barbara Davis Center (BDC) and compare these changes over time. STUDY DESIGN: A retrospective chart review was performed of patients ages 0-20 years at diagnosis of T1D and type 2 diabetes who were seen at the BDC, were living within Colorado at diagnosis, and were seen within 1 month of diagnosis between 1996 and 2010. The review included age of onset, sex, month and season of onset, islet autoantibodies, diabetes type, hemoglobin A1c level, and body mass index. RESULTS: Newly diagnosed youth with diabetes (n = 2841) were seen at the BDC between 1996 and 2010. Of these, 2686 (94.4%) had T1D. The number of newly diagnosed youth increased over the 15 years by 5.71% per year when adjusted for population (P < .0001). When analyzed in 5-year periods, the average number of new onset T1D cases, age-adjusted to the population, increased by 9.46% per year from 1996-2000 to 2001-2005. The increase was only 4.86% per year from 2001-2005 to 2006-2010. Islet autoimmune markers appeared to correlate with changes in T1D new onset cases. CONCLUSION: T1D in youth increased significantly from the late 1990s-2005 and has increased at a lesser rate more recently. Data suggests that even though T1D has increased in all age groups, the greatest increase was in the 5-9 year age category.

Morbidity and mortality of diabetic ketoacidosis with and without insulin pump care.

Diabetic ketoacidosis (DKA) is one of the most common, costly, and dangerous acute complications in people with type 1 diabetes (T1D). Although DKA has been reported to occur with less frequency than severe hypoglycemia, it is associated with a higher mortality rate and is the leading cause of diabetes-related deaths in children and adolescents. The most common risk factor for DKA is lack of adherence to insulin treatment. Other factors include underinsurance, psychiatric disorders, occlusion of insulin pump infusion sets, and illness. It has been suggested that use of continuous subcutaneous insulin infusion therapy may increase the risk for DKA, although clinical trials have not supported this claim. Expert care within a T1D specialty clinic may help reduce the risk of DKA mortality. Further advances are needed in developing new technologies and methods to improve glycemic control in intensively treated patients without increasing the risk of acute complications. The purpose of this review is to discuss DKA morbidity and mortality in youth with T1D, particularly in relation to insulin pump use.

Recent advances in the prevention of hypoglycemia in type 1 diabetes.

Iatrogenic hypoglycemia is one of the chief barriers to optimal glycemic control in people with type 1 diabetes (T1D). As a common contributor to morbidity and mortality in T1D, severe hypoglycemia (SH) is also a major fear for people with T1D and their families. Consequently, fear of hypoglycemia and hypoglycemia-avoidant behaviors are predominant limiting factors in achieving euglycemia in people with T1D. Nocturnal SH and hypoglycemia unawareness are prevalent obstacles in the detection of hypoglycemia which further impair the prevention and treatment of SH. Various strategies and technologies have already been developed to help detect and prevent hypoglycemia, including improved patient education, frequent self-monitoring of blood glucose levels, the use of rapid-acting and basal insulin analogs, continuous subcutaneous insulin infusion therapy, exercise-related insulin modifications, and continuous glucose monitors. The efficacy of these methods is well established, but further advances are still needed. The purpose of this review is to describe these currently available methods and to emphasize recent progress related to the prevention of hypoglycemia in T1D.