Diabetes Mellitus (Pediatric)

Diabetes mellitus in children is a chronic metabolic disorder characterized by hyperglycemia due to absolute or relative insulin deficiency, leading to disturbances in carbohydrate, fat, and protein metabolism.

Definition

Epidemiology

Type 1 diabetes is the most common form in children, accounting for 90–95% of cases under 18 years
Incidence varies by region; higher in northern Europe and lower in Asia
Peak onset between 4–6 years and 10–14 years
Slight male predominance in some populations
Type 2 diabetes is increasing due to obesity and sedentary lifestyle

Etiology

Type 1 diabetes: autoimmune destruction of pancreatic beta cells
Genetic predisposition: HLA-DR3, DR4 alleles increase risk
Environmental triggers: viral infections (enteroviruses), dietary factors
Type 2 diabetes: insulin resistance due to obesity, sedentary lifestyle, family history
Other causes: monogenic diabetes (MODY), secondary diabetes from pancreatitis or medications

Pathophysiology

Type 1 diabetes: autoimmune beta-cell destruction leads to absolute insulin deficiency
Hyperglycemia results from decreased glucose uptake and increased gluconeogenesis
Type 2 diabetes: peripheral insulin resistance with compensatory hyperinsulinemia
Progressive beta-cell dysfunction eventually leads to insulin deficiency
Chronic hyperglycemia causes microvascular and macrovascular complications
Ketosis and diabetic ketoacidosis occur in severe insulin deficiency