In 2021, 537 million people, representing 1 in 10 adults, were living with diabetes worldwide. The total number is predicted to rise to 643 million (1 in 9 adults) by 2030 and reach 784 million (1 in 8 adults) by 2045¹. Some types of diabetes are triggered by genetic changes or autoimmune conditions, while others are more strongly associated with lifestyle.
Diabetes manifests differently in children and adults, with distinct symptoms, diagnostic procedures, treatment options, and support needs. Exploring these differences is critical, as it informs patient-centred care that is crucial in managing this lifelong condition.
Symptoms of diabetes
Symptoms in children
Kids are most likely to develop T1D, and symptoms often appear suddenly and intensely. Caregivers may notice that their child suddenly has an increased appetite, wanting to eat at all hours or never feeling full. Similarly, they may show signs of excessive thirst both day and night. Children may begin to lose weight rapidly despite increased food and drink intake. Another noticeable change is that they need to urinate more frequently, where a commonly missed sign of diabetes is bedwetting in a child who did not previously have accidents at night. In addition, extreme fatigue, blurred vision, and mood swings are also symptoms of T1D. Unfortunately, because of the quickness with which T1D tends to develop, many people only become aware of it once they seek medical attention for diabetic ketoacidosis.
Symptoms in Adults
Symptoms for most other types of diabetes, particularly T2D, tend to develop over the course of many years rather than show up quickly and acutely. Many people miss the signs and live with undiagnosed diabetes for a long time until symptoms of severe hyperglycemia appear, such as unintentional weight loss, increased appetite or thirst, excessive urination, or blurred vision². According to IDF¹, in general, T2D symptoms are much less dramatic than those of T1D and may, in fact, be completely symptomless. Determining the exact time of T2D onset is often impossible. There is a risk linked to obesity, advanced age, certain ethnicities, and family history.
Gestational diabetes is usually diagnosed following a routine Oral Glucose Test during the second or third trimester of pregnancy. Since the symptoms of diabetes can often correlate to typical pregnancy-related symptoms, screening of all pregnant women is recommended.
Types of treatment
General forms
Two main categories of treatment for diabetes are common across all types. The first is blood glucose monitoring. Extreme fluctuations can have severe consequences for both the short- and long-term health of people living with diabetes. Glucose meters measure glucose levels at specific times via finger prick, while continuous glucose monitors are devices attached to the skin which monitor changes in blood glucose in real time4. Both allow data to be exported and uploaded to apps, where trends can easily be indicated and evaluated.
The second main category of diabetes treatment is insulin therapy. The most common forms of insulin delivery are via syringes or pre-filled insulin pens. Some smart insulin pens can recall details such as dose amounts and times. Insulin pumps, on the other hand, deliver fast-acting insulin directly through a cannula or tube. They have been steadily growing in popularity over the last several decades. Automated Inulin Delivery Systems, or closed-loop systems, are newer and consist of a pump, a continuous glucose monitor, and an algorithm to calculate insulin delivery doses³.
Treatment Considerations in Children
It is important to remember that when it comes to diabetes treatment and management, the care model for children must differ from that of adults, as children’s psychological, emotional, and physical development constantly evolves. Children are often less able to identify the symptoms of hyperglycemia or hypoglycemia, may be unable to be responsible for the maintenance and care of various diabetes treatment supplies or be unable to calculate and/or administer insulin doses independently. Young children may need 100% assistance from a caregiver, while older children and adolescents can begin moving toward a more independent care model over time.
Children may also require care plans at school, including a nurse or other professional responsible for helping the child manage their diabetes during the school day or on field trips. Children’s daily activity levels can change frequently, requiring insulin dosing and delivery adjustments.
Treatment Considerations in Adults
Glucose monitoring and insulin therapy are on the everyday agenda of grown-ups. People with Type 2 and Gestational Diabetes must also consider lifestyle changes that suit their chronic condition. Adults who are overweight or inactive need to start an exercise plan after a consultation with their doctor. Nutritional counselling will help incorporate dietary changes to keep blood glucose levels within recommended ranges.
Adults are encouraged to regularly screen for cholesterol, blood pressure, kidney disease, retinopathy, and foot ulcers, as all may be developed due to diabetes complications.
Management Tools
Regardless of the treatment plan type, managing all the different aspects of diabetes is vital. Keeping track of data such as insulin doses, HbA1c, injection zones, and food intake can be time-consuming and complicated. This can lead to overwhelm and less than consistent tracking and management practices. The original paper logbook has now been replaced by more convenient and powerful technological options, including apps that are accessible from anywhere. The Diabetes:M app is one example of a comprehensive diabetes management tool, perfect for managing diabetes in both children and adults.
Diabetes:M is a cloud-based mobile app designed for people with diabetes and pre-diabetes. Its simple interface makes it user-friendly, even for children, yet it is intended to be an all-in-one management tool. The Logbook function allows you to track everything from insulin doses to HbA1c values, ketones, and injection zones. The food database empowers meal tracking; in available regions, the bolus advisor can help calculate insulin doses. The app can generate a variety of graphs and charts in an instant, which can be used to detect trends, adjust treatment, and share with medical professionals online. No more dragging around handwritten logbooks!
For parents of a child living with diabetes, like I am, this app helps keep their child’s diabetes-related information in one safe place while making things simpler for everyone. Multiple users mean that children, caregivers, and medical professionals can access the same data in real-time. Diabetes management can be stressful for children. Apps like Diabetes:M help make things easier.
Psychological and Emotional Factors
Managing diabetes can be daunting. With so many factors to think about, individuals living with diabetes can be at higher risk of developing mental health conditions such as depression.
Support for children
Studies have shown that adolescents with Type 1 Diabetes “tend to show 2–3 times the rate of psychological distress as their peers without diabetes”4. The desire to fit in with their classmates can lead to hiding or minimizing diabetes care in their presence, and age-appropriate decision-making skills can sometimes be a factor in risk-taking behaviours in children and teens.
Support for adults
For adults, concerns about the long-term effects of undiagnosed or unmanaged diabetes can be worrisome. Changing one’s lifestyle in adulthood requires a shift in mindset, and they often need the support of family and their medical team to help them manage those changes. Grown-ups may need help changing their lifestyles and adopting habits that will help them to manage their diabetes-related symptoms optimally.
Education and support
Considerations in children
As children move through adolescence into adulthood, their bodies and minds undergo many developmental changes. A one-size-fits-all approach to education and support would need to be revised. It is recommended that children and adolescents with diabetes receive care specifically targeted to their age and level of cognitive development. Families and/or caregivers are encouraged to participate in the management of a child’s diabetes care on a sliding scale that can begin with 100% of the responsibility, eventually tapering off to the child taking more and more responsibility for their own care as they move through adolescence into adulthood4.
Considerations in adults
Adults may require additional support regarding lifestyle changes around physical activity, and risk factors for other diagnoses. Lifestyle management education encompasses multiple areas, including nutritional knowledge around healthy eating, carbohydrate counting, food preferences and meal planning, and calculating insulin for those requiring it. Physical activity and exercise training help individuals understand both the benefits of physical activity, the potential impact on blood glucose levels, and how to manage those changes.
References
- International Diabetes Federation (2022). IDF Diabetes Atlas 2021, 10th Edition. https://diabetesatlas.org/idfawp/resource-files/2021/07/IDF_Atlas_10th_Edition_2021.pdf
- Banday, M. Z., Sameer, A. S., & Nissar, S. (2020). Pathophysiology of diabetes: An overview. Avicenna journal of medicine, 10(04), 174-188. DOI: 10.4103/ajm.ajm_53_20. https://www.thieme-connect.com/products/ejournals/html/10.4103/ajm.ajm_53_20
- Draznin, B., Aroda, V. R., Bakris, G., Benson, G., Brown, F. M., Freeman, R., … & Kosiborod, M. (2022). 7. Diabetes Technology: Standards of Medical Care in Diabetes-2022. Diabetes Care, 45(Supplement_1), S97-S112. DOI: 10.2337/dc22-s007. https://europepmc.org/article/med/34964871
- Chiang, J. L., Maahs, D. M., Garvey, K. C., Hood, K. K., Laffel, L. M., Weinzimer, S. A., & Schatz, D. (2018). Type 1 diabetes in children and adolescents: a position statement by the American Diabetes Association. Diabetes care, 41(9), 2026-2044. Type 1 Diabetes in Children and Adolescents: A Position https://diabetesjournals.org/care/article/41/9/2026/40739/Type-1-Diabetes-in-Children-and-Adolescents-A
