Diabetes In Childhood And Adolescence

391 Pages·2005·2.73 MB·English

by  F. Chiarelli

Diabetes in Childhood and Adolescence
Pediatric and Adolescent
Medicine
1
Vol. 0
Series Editors
W. Kiess Leipzig
D. Branski Jerusalem
Diabetes in Childhood
and Adolescence
Volume Editors
F. Chiarelli Chieti
K. Dahl-Jørgensen Oslo
W. Kiess Leipzig
40 figures, 1 in color, and 40 tables, 2005
Basel·Freiburg·Paris·London·New York·
Bangalore·Bangkok·Singapore·Tokyo·Sydney
Prof.Francesco Chiarelli Prof.Knut Dahl-Jørgensen
Clinica Pediatrica Diabetes Research Centre
Ospedale Policlinico Chieti Pediatric Department
Chieti, Italy Ullevål University Hospital Oslo
Oslo, Norway
Prof.Wieland Kiess
Universitätsklinik und Poliklinik
für Kinder und Jugendliche
Universität Leipzig, Leipzig, Germany
Library of Congress Cataloging-in-Publication Data
Diabetes in childhood and adolescence / volume editors, F. Chiarelli, K.
Dahl-Jørgensen, W. Kiess.
p. ; cm. – (Pediatric and adolescent medicine, ISSN 1017-5989 ; v.
10)
Includes bibliographical references and index.
ISBN 3-8055-7766-4 (hard cover : alk. paper)
1. Diabetes in children. 2. Diabetes in adolescence.
[DNLM: 1. Diabetes Mellitus–Adolescent. 2. Diabetes Mellitus–Child.
WK 810 D5375235 2005] I. Chiarelli, F. (Francesco) II. Dahl-Jørgensen, K.
(Knut) III. Kiess, W. (Wieland) IV. Series.
RJ420.D5D533 2005
618.92(cid:1)462–dc22
2005003110
Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents®and
Index Medicus.
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However, in view of ongoing research, changes in government regulations, and the constant flow of information
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when the recommended agent is a new and/or infrequently employed drug.
All rights reserved. No part of this publication may be translated into other languages, reproduced or
utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying,
or by any information storage and retrieval system, without permission in writing from the publisher.
© Copyright 2005 by S. Karger AG, P.O. Box, CH–4009 Basel (Switzerland)
www.karger.com
Printed in Switzerland on acid-free paper by Reinhardt Druck, Basel
ISSN 1017–5989
ISBN 3–8055–7766–4
Contents
VII Preface
1 Etiopathogenetic Aspects of Type 1Diabetes
Knip, M. (Tampere)
28 Susceptibility to Type 1Diabetes:Genes and Mechanisms
Contu, D.; Cucca, F. (Cagliari)
57 Autoimmunity in Type 1Diabetes mellitus
Achenbach, P.; Ziegler, A.-G. (Munich)
72 Neonatal Diabetes mellitus
Polak, M. (Paris); Shield, J. (Bristol)
84 Diagnosis and Management of MODY in a Pediatric Setting
Njølstad, P.R.; Molven, A.; Søvik, O. (Bergen)
94 Diabetic Ketoacidosis
Brink, S.J. (Boston, Mass.)
122 Insulin Treatment
Kapellen, T.M.; Galler, A.; Kiess, W. (Leipzig)
139 Medical Nutrition Therapy of Children and Adolescents
with Diabetes
Virtanen, S.M. (Tampere)
V
150 Continuous Subcutaneous Insulin Infusion in Childhood
and Adolescence
Phillip, M.; Weintrob, N.; Shalitin, S. (Petah-Tikva)
163 Quality Management in Pediatric Diabetology
Holl, R.W.; Grabert, M.; Krause, U.; Schweiggert, F. (Ulm)
181 Sports and Physical Activity in Children and Adolescents
with Type 1Diabetes mellitus
Raile, K.; Galler, A.; Kapellen, T.M.; Noelle, V.; Kiess, W. (Leipzig)
190 Invasive and Noninvasive Means of Diabetes Self-Management
Deiss, D.; Hartmann, R.; Kordonouri, O. (Berlin)
202 Adolescence
Dunger, D.B.; Acerini, C.L.; Ahmed, M.L. (Cambridge)
225 Diabetic Nephropathy in Children and Adolescents
Chiarelli, F.; Santilli, F. (Chieti)
259 Diabetic Autonomic and Peripheral Neuropathy
Donaghue, K.C. (Sydney); Al-Jasser, A. (Sydney/Riyadh);
Maguire, A. (Sydney)
279 Macrovascular Disease
Dahl-Jørgensen, K.; Larsen, J.R. (Oslo)
299 Hypoglycemia in Children and Adolescents with Type 1Diabetes
Blasetti, A.; Verrotti, A.; de Michele, G.; Chiarelli, F. (Chieti)
314 Diabetic Retinopathy in Children and Adolescents with Type 1Diabetes
Bittner, C. (Hannover); Kordonouri, O. (Berlin); Danne, T. (Hannover)
329 Complications and Consequences
Kapellen, T.M.; Galler, A.; Raile, K.; Kiess, W. (Leipzig)
347 Type 2 Diabetes mellitus in Childhood
Piscopo, M.A.; Rigamonti, A.; Chiesa, G.B.; Bettini, S.; Azzinari, A.;
Bonfanti, R.; Viscardi, M.; Meschi, F.; Chiumello, G. (Milan)
362 Beta-Cell Function Replacement by Islet Transplantation
and Gene Therapy
Falqui, L. (Milan)
373 Author Index
374 Subject Index
Contents VI
Preface
Diabetes mellitus is one of the most frequent chronic diseases affecting
children and adolescents. Next to obesity it is the most common metabolic
disorder in childhood and adolescence. The number of young children being
diagnosed with type 1 diabetes is increasing worldwide. An epidemic of type 2
diabetes already at a young age is being observed in most societies around the
world.
This book aims to increase physicians’knowledge and understanding of
diabetes in childhood and adolescence as well as to summarize the most recent
scientific discoveries related to diabetes. Leading experts from the USA,
Europe and Israel have gathered to provide a state-of-the-art summary of
today’s knowledge in the field of pediatric and adolescent diabetes. Several
chapters deliver insight into the basic understanding of which factors contribute
to or prevent the development of diabetes in young people. For example,
Achenbach and colleagues outline the basic concepts underlying the auto-
immune pathogenesis of type 1 diabetes. Knip from Helsinki summarizes the
global knowledge on the etiopathogenesis of type 1 diabetes and reports on the
very extensive experience and scientific contributions from his group in
Finland. Other contributions provide tools for the clinician to manage the care
of the child and adolescent with diabetes. For instance, continuous subcuta-
neous insulin infusion regimens are nicely developed by the group of Phillip in
Tel Aviv and the management of diabetic ketoacidosis in a child or adolescent
is taught by Brink from Boston. Diabetes complications occur even at a young
age and may be prevented. This fact is acknowledged in a number of excellent
chapters such as the ones by Bittner and coworkers on retinopathy, Chiarelli and
VII
coworkers on nephropathy, Dahl-Jørgensen and coworkers on macrovascular
disease, or Donaghue on autonomic and peripheral neuropathy. In addition,
knowledge from the latest scientific studies on the molecular biology of
diabetes is also presented. For example, Cucca from Cagliari outlines the most
recent advances in the genetics of type 1 diabetes. The contribution by Polak’s
group from Paris reviews our knowledge on neonatal diabetes and the underly-
ing genetics. In addition, Falqui from Milan describes the potential implications
of gene therapy and islet transplantation for the future cure of diabetes.
The editors would like to extend their gratitude and appreciation to the
authors who are all world authorities in their field. To have worked with them has
made this project both a great joy and a success. In addition, the understanding,
patience, great care and enthusiasm with which the publisher, Dr. Thomas Karger
and his team have supported this book are gratefully acknowledged.
Francesco Chiarelli,Chieti
Knut Dahl-Jørgensen,Oslo
Wieland Kiess,Leipzig
Preface VIII
Chiarelli F, Dahl-Jørgensen K, Kiess W (eds): Diabetes in Childhood and Adolescence.
Pediatr Adolesc Med. Basel, Karger, 2005, vol 10, pp 1–27
Etiopathogenetic Aspects of
1
Type Diabetes
Mikael Knip
Hospital for Children and Adolescents, University of Helsinki, Helsinki, and
Department of Paediatrics, Tampere University Hospital, Tampere, Finland
Type 1 diabetes is perceived as a chronic immune-mediated disease with a
subclinical prodromal period characterized by selective loss of insulin-producing
(cid:1)-cells in the pancreatic islets in genetically susceptible subjects. The most
important genes contributing to disease susceptibility are located in the HLA
class II locus on the short arm of chromosome 6 [1]. Nevertheless, only a rela-
tively small proportion, i.e. less than 10%, of genetically susceptible individuals
progress to clinical disease. This implies that additional factors are needed to
trigger and drive (cid:1)-cell destruction in genetically predisposed subjects. Clinical
type 1 diabetes represents end-stage insulitis, and it has been estimated that at
the time of diagnosis only 10–20% of the insulin-producing (cid:1)-cells are still func-
tioning. Environmental factors have been implicated in the pathogenesis of type
1 diabetes both as triggers and potentiators of (cid:1)-cell destruction [2–4], although
the contribution of any individual exogenous factor has not been definitely
proven so far.
Natural History of Type 1 Diabetes
The clinical presentation of type 1 diabetes is preceded by an asympto-
matic period of variable duration [5]. Aggressive (cid:1)-cell destruction may lead to
disease manifestation within a few months in young children, while in other
individuals the process will continue for years, in some cases even for more
than 10 years, before the eventual presentation of clinical disease.
The appearance of diabetes-associated autoantibodies is the first detect-
able sign of emerging (cid:1)-cell autoimmunity. There are four disease-related