Monatsschrift Kinderheilkunde

, Volume 155, Issue 2, pp 179–191

Diabetes mellitus im Kindes- und Jugendalter

CME Weiterbildung • Zertifizierte Fortbildung

Zusammenfassung

Diabetes mellitus Typ 1 ist eine der häufigsten chronischen Krankheiten des Kindes- und Jugendalters. Evidenzbasierte Leitlinien der DDG und der DGKJ liegen vor. Bei der Erstmanifestation weisen etwa 20% eine Ketoazidose auf. Assoziierte Erkrankungen sind bei ungewöhnlichen klinischen Symptomen zu bedenken. Kinder und Jugendliche mit Diabetes mellitus müssen durch ein multidisziplinäres Team (Kinderarzt, Kinderdiabetologe, Psychologe, Sozialpädagoge, Ophthalmologe, Ernährungsberater, Krankenschwester, Diabetesberater) behandelt werden. Damit ist die (Mit)betreuung in regionalen, spezialisierten Zentren unabdingbar. Die Patienten werden in ihrem eigenen psychosozialen Umfeld unter Miteinbeziehung der Familie betreut. Die moderne Insulintherapie ermöglicht heute ein normales somatisches Gedeihen und eine normale psychosoziale Entwicklung. Prävention und frühe Behandlung der Folgeerkrankungen bleiben ein wichtiges Anliegen. Ein neuer Aspekt ist, dass bei übergewichtigen Jugendlichen heute zunehmend nach dem Vorliegen eines Typ-2-Diabetes gesucht werden muss.

Schlüsselwörter

Diabetes Kinder Jugendliche Komplikationen Insulintherapie 

Diabetes mellitus in childhood and adolescence

Abstract

Type 1 diabetes is one of the most common chronic disorders in childhood and adolescence. Evidence based guidelines from the German Diabetes Society (Deutsche Diabetes Gesellschaft) and the German Society for Childhood and Adolescent Medicine (Deutsche Gesellschaft für Kinderheilkunde und Jugendmedizin) are available. At its first manifestation, about 20% of patients show a ketoacidosis. Associated illnesses should be considered when unusual clinical symptoms are present. Children and adolescents with diabetes must be treated by a multidisciplinary team (pediatrician, pediatric diabetician, psychologist, social education specialist, ophthalmologist, nutritional adviser, nurse, and diabetician). Combined with this is the necessity for medical supervision by specialized, regional centers. The patients are cared for in their own psychosocial environment with the involvement of their family. Modern insulin therapy allows for normal somatic growth and psychological development. Prevention and the early treatment of associated illnesses remain important. It is nowadays also important to take diabetes type 2 into consideration in overweight adolescents.

Keywords

Diabetes Childhood Adolescence Complications Insulin therapy 

Literatur

  1. 1.
    American Diabetes Association (1998) Practice recommendations. Diabetes Care 23: 381–389Google Scholar
  2. 2.
    American Diabetes Association (2000) Type 2 diabetes in children and adolescents. Diabetes Care 23: 381–389PubMedGoogle Scholar
  3. 3.
    Bartus B, Schlottke P, Kiess W (2001) Erfassung der Lebensqualität von Jugendlichen mit Typ 1 Diabetes – eine multizentrische Studie. Kinder Jugendmed 1: 72–80Google Scholar
  4. 4.
    Busse FP, Hiermann P, Galler A et al. (2007) Evaluation of patients‘ opinion and metabolic control after transfer of young adults with type 1 diabetes from a pediatric diabetes clinic to adult care. Horm Res 67:132–138CrossRefGoogle Scholar
  5. 5.
    Chiarelli F, Dahl-Jörgensen K, Kiess W (eds) (2005) Diabetes in childhood and adolescence. Karger, BaselGoogle Scholar
  6. 6.
    Danne T, Aman A, Schober E et al. (2003) A comparison of postprandial and preprandial administration of insulin Aspart in children and adolescents with type 1 diabetes. Diabetes Care 26: 2359–2364PubMedGoogle Scholar
  7. 7.
    Danne T, Beyer P, Holl RW et al. (2004) Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. Leitlinien der DDG. Deutsche Diabetes-Gesellschaft e. V., Düsseldorf, http://www.diabetes-kinder.de/pdf/leitlinie_endfassung.pdf
  8. 8.
    De Block CEM, De Leeuw ICH, Van Gaal LF (2005) Impact of overweight on chronic microvascular complications in type 1 diabetic patients. Diabetes Care 28: 1649–1655PubMedGoogle Scholar
  9. 9.
    Ellis DA, Frey MA, Naar-King S et al. (2005) Use of multisystemic therapy to improve regimen adherence among adolescencts with type 1 diabetes in chronic poor metabolic control. Diabetes Care 28: 1604–1610PubMedGoogle Scholar
  10. 10.
    Galler A, Kapellen T, Stange T et al. (2005) Epidemiologie des Diabetes mellitus im Kindesalter: Daten aus dem sächsischen Kinder-Diabetes Register. Kinder Jugendmed 5: 161–224Google Scholar
  11. 11.
    Grant RW, Buse JB, Meigs JB (2005) Quality of diabetes care in US academic medical centers. Diabetes Care 28: 337–342PubMedGoogle Scholar
  12. 12.
    Green A, Patterson CC (2001) Trends in the incidence of childhood-onset diabetes in Europe 1989–1998. Diabetologia [Suppl 3] 44: B3–B8Google Scholar
  13. 13.
    Gross JL, De Azevedo MJ, Silveiro SP et al. (2005) Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care 28: 176–188Google Scholar
  14. 14.
    Holl RW (1997) Sekundäre Diabetesformen (Übersicht). Monatsschr Kinderheilk 136: 145–156Google Scholar
  15. 15.
    Holl R (2001) Diabetes mellitus In: Reinhardt D, Creutzig U, Kiess W et al. (Hrsg) Leitlinien Kinderheilkunde und Jugendmedizin (Deutsche Gesellschaft für Kinderheilkunde). Urban & Fischer, München JenaGoogle Scholar
  16. 16.
    Holl RW, Teller WM, Heinze E (1996) Semilente at bedtime is superior to NPH-insulin for the suppression of the dawn-phenomenon in adolescents with type 1 diabetes. Exp Clin Endocrinol Diabetes 104: 360–364PubMedGoogle Scholar
  17. 17.
    Icks A, Rosenbauer J, Haastert B et al. (2001) Hospitalization among diabetic children and adolescents and non-diabetic control subjects: a prospective population-based study. Diabetologia [Suppl 3] 44: B87–B92Google Scholar
  18. 18.
    International Society for Pediatric and Adolescent Diabetes (2000) ISPAD Consensus Guidelines 2000. Medical Forum International, ZeistGoogle Scholar
  19. 19.
    Kapellen TM, Galler A, Nietzschmann U et al. (2001) Prävalenz von Ketoazidosen bei Manifestation des Diabetes mellitus Typ 1 in einem Zentrum für pädiatrische Diabetologie. Monatsschr Kinderheilk 149: 679–682CrossRefGoogle Scholar
  20. 20.
    Kapellen T, Raile K, Blüher M et al. (2001) Typ-2-Diabetes bei Kindern und Jugendlichen – ein weltweites Problem. Diabetes Stoffwechsel 10: 165–169Google Scholar
  21. 21.
    Kapellen TM, Heim K, Nietzschmann U et al. (2002) Changes in pediatric diabetes care throughout a 30 year period at one institution. Pediatr Diabetol 3: 70–73CrossRefGoogle Scholar
  22. 22.
    Kapellen TM, Leludas C, Dost A et al. (2002) Higher frequency of paronychia (nail bed infections) in pediatric and adolescent patients with type 1 diabetes than in nondiabetic peers: presence of signs of early neuropathy. J Pediatr Endocrinol Metab 16: 751–758Google Scholar
  23. 23.
    Kapellen TM, Siekmeyer W, Galler A et al. (2005) Behandlungsstrategien für Kinder und Jugendliche mit diabetischer Ketoazidose. Kinder Jugendmed 5: 1–5Google Scholar
  24. 24.
    Kaufman FR (2005) Intensive management of type 1 diabetes in young children. Lancet 365: 737–738PubMedGoogle Scholar
  25. 25.
    Kiess W (1999) Diabetes mellitus im Kindesalter In: Kruse K (Hrsg) Pädiatrische Endokrinologie, 2. Aufl. Thieme, Stuttgart New York, S 271–312Google Scholar
  26. 26.
    Kiess W, Galler A, Reich A et al. (2001) Clinical aspects of obesity in childhood and adolescence. Obes Rev 2: 29–36CrossRefPubMedGoogle Scholar
  27. 27.
    Kiess W, Galler A, Schmidt A et al. (2001) Fathers of children with diabetes and their role in coping strategies in the family. J Pediatr Endocrinol Metab [Suppl 1] 14: 639–643Google Scholar
  28. 28.
    Kiess W, Gausche R, Keller A et al. (2001) Computer-guided, population based screening system for growth disorders (CrescNet) and on-line generation of normative data for growth and development. Horm Res [Suppl 1] 56: 59–66Google Scholar
  29. 29.
    Kordonouri O, Klinghammer A, Lang EB et al. (2002) Thyroid autoimmunity in children and adolescents with type 1 diabetes. Diabetes Care 25: 1346–1350PubMedGoogle Scholar
  30. 30.
    Laing SP, Jones ME, Swerdlow AJ et al. (2005) Psychosocial and socioeconomic risk factors for premature death in young people with type 1 diabetes. Diabetes Care 28: 1618–1623PubMedGoogle Scholar
  31. 31.
    Lohmann T, Nietzschmann U, Kapellen T et al. (2000) LADY-like – is there a „latent autoimmune diabetes in the young“? Diabetes Care 23: 1707–1708PubMedGoogle Scholar
  32. 32.
    Lorini R, d’Annunzio G, Vitali L et al. (1996) IDDM and autoimmune thyroid disease in the pediatric age group. J Pediatr Endocrinol Metab [Suppl 1] 9: 89–94Google Scholar
  33. 33.
    Neu A, Willasch A, Ehehalt S et al. (2001) Diabetes incidence in children of different nationalities: an epidemiological approach to the pathogenesis of diabetes. Diabetologia [Suppl 3] 44: B21–26Google Scholar
  34. 34.
    Neumeir C, Ansari H, Döhlemann C et al. (1997) Ambulante 24-Stunden-Blutdruckmessung bei Kindern und Jugendlichen mit Diabetes mellitus Typ I – Beziehung zu Diabetesdauer, HbA1c, Eiweißausscheidung im Urin, Serumcholesterin und Body-Mass-Index. Monatsschr Kinderheilk 145: 370–375CrossRefGoogle Scholar
  35. 35.
    Noelle V, Schwarz HP, Kiess W et al. (2001) Moderne Behandlungskonzepte für Kinder und Jugendliche mit Typ 1 Diabetes mellitus. Monatsschr Kinderheilk 149: 650–659CrossRefGoogle Scholar
  36. 36.
    Onkamo P, Väänänen S, Karvonen M et al. (1999) Worldwide increase in incidence of type I diabetes — the analysis of the data on published incidence trends. Diabetologia 42: 1395–1403CrossRefPubMedGoogle Scholar
  37. 37.
    Ortega-Rodriguez E, Levy-MC, Tubiana N et al. (2001) Emergence of type 2 diabetes in an hospital based cohort of children with diabetes mellitus. Diabetes Metab 27: 574–578PubMedGoogle Scholar
  38. 38.
    Peyer RC, Bryden KS, Neil HAW et al. (2005) The relationship of disordered eating habits and attitudes to clinical outcomes in young adult females with type 1 diabetes. Diabetes Care 28: 84–88PubMedGoogle Scholar
  39. 39.
    Radetti G, Paganini C, Gentili L et al. (1995) Frequency of Hashimoto’s thyroiditis in children with type 1 diabetes mellitus. Acta Diabetol 32: 121–124CrossRefPubMedGoogle Scholar
  40. 40.
    Schober E, Rami B, Granditsch G et al. (2002) Coeliac disease in children and adolescents with type 1 diabetes mellitus: to screen or not, to treat or not? Horm Res [Suppl 1] 57: 97–100Google Scholar
  41. 41.
    Schober E, Schoenle E, Van Dyk J et al. (2002) Comparative trial between insulin glargine and NPH insulin in children and adolescents with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 15: 369–376PubMedGoogle Scholar
  42. 42.
    Silverstein J, Klingensmith G, Copeland K et al. (2005) Care of children and adolescents with type 1 diabetes. Diabetes Care 28: 186–212PubMedGoogle Scholar
  43. 43.
    Sinha R, Fisch G, Teague B et al. (2002) Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 346: 802–810CrossRefPubMedGoogle Scholar
  44. 44.
    Weintrob N, Benzaquen H, Galatzer A et al. (2003) Comparison of continuous subcutaneous insulin infusion and multiple daily injection regimens in children with type 1 diabetes: a randomized open crossover trial. Pediatrics 112: 559–564Google Scholar
  45. 45.
    Weissberg-Benchell J, Antisdel-Lomaglio J, Seshadri R (2003) Insulin pump therapy: a meta-analysis. Diabetes Care 26: 1079–1087PubMedGoogle Scholar
  46. 46.
    Wilson DM, Buckingham BA, Kunselman EL et al. (2005) A two-center randomized controlles feasibility trial of insulin pump therapy in young children with diabetes. Diabetes Care 28: 15–19PubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  1. 1.Universitätsklinik für Kinder und JugendlicheUniversität LeipzigLeipzigDeutschland

Personalised recommendations