Paediatric diabetes: achieving practical, effective insulin therapy in type 1 and type 2 diabetes

Both type 1 and type 2 diabetes can occur in children and adolescents. Type 1 diabetes is the most common chronic disease in children in the developed countries and the number of adolescents with type 2 diabetes is rising as a consequence of the obesity epidemic. As they grow, children and adolescents with diabetes have special and changing needs; these must be recognized and addressed as there are major physiological, medical, psychological, social and emotional differences in adults with diabetes. Glycaemic control is important to prevent or delay long-term complications also in the paediatric age group. This goal is often achieved using insulin. However, practical issues associated with insulin use in paediatric patients include attainment of target glycaemic levels without increased risk of hypoglycaemia, hormone-driven fluctuations in insulin requirements, and the psychological and social impacts of weight gain and puberty. This article reviews the advances that are helping to overcome these issues and enable paediatric patients to achieve their treatment goals.

Advanced insulin formulations, particularly insulin analogues, tailored insulin regimens and delivery systems combined with age-appropriate education, patient/carer involvement and ongoing support from the wider diabetes team will assist in the effective management of diabetes among children and adolescents.