A recent Lancet article has predicted a doubling of new cases of type 1 diabetes in European children aged under 5, and a 70% rise in cases in children under 15 years – an incidence rate exceeding all previous predictions. Studies in the USA and other countries also suggest similar trends.
In the latest issue of Diabetic Hypoglycemia, Dr Tim Jones and Dr Trang Ly of the University of Western Australia maintain that, despite modern therapy, hypoglycemia remains a critical concern in these young patients. Their parents and clinicians may become anxious, as many children are too young to manage their own blood glucose levels, leading to an increased risk of hypoglycemia.
Jones and Ly make the case that "children are not small adults". Consequently, the approach to achieving glycemic control in these young patients should be different to that in adults. The authors discuss the physiologic and behavioral mechanisms underlying these differences and cover other aspects of childhood hypoglycemia, together with guidelines for treatment.
To complement the feature article, Professor Christopher Ryan of the editorial board discusses the practical and ethical issues limiting experimental studies of hypoglycemia in very young children with diabetes. He makes the case for empirical observation, and comments:
“While well designed observational studies will never address all our questions, they can improve our understanding of how younger children recognize hypoglycemia, and how their responses to it affect their mental state and behavior”.