World Diabetes Month—a Global Event for Children

November is World Diabetes Month. We are living at a time in which advances in technology have resulted in great hope for improved clinical care for children with diabetes. The promise of continuous glucose monitoring and the hope of an “artificial” pancreas are possible therapeutic options for children. Children can now use continuous glucose monitoring systems in their daily diabetes care (N Engl J Med 2010; 363:311-20). Sensors that relay glucose levels back to an insulin pump, through a computer which can regulate insulin delivery to achieve euglycemia, are being used in controlled research settings. In Europe, an insulin sensor and pump system is available that will discontinue insulin delivery when a low glucose value is determined by the sensor, thus avoiding severe hypoglycemia. Truly exciting times! Motivated families with the financial ability, knowledge, and desire to achieve optimal glucose control now can have glycemic values previously unreachable, and not thought possible only a few years ago, without an increased risk for hypoglycemia. Our new challenge is to find the determination to ensure that all children who will benefit from this rapidly advancing technology will have it available to them. If the technology fulfills its promise, which it seems capable of doing, children and their parents will no longer need to fear nocturnal hypoglycemic seizures or the microvascular ravages of diabetes, which have been too common in those living with diabetes for many years. Although these new technologies are exciting, the rate of diabetic ketoacidosis (DKA) in new-onset diabetes is too high. DKA and its associated excessive hyperglycemia, dehydration, acidosis, and altered level of consciousness are too commonly the presenting signs and symptoms of childhood diabetes. Surprisingly, DKA, due to delayed diagnosis of type 1 diabetes, is an increasing health problem, even in the US. The DKA rates at onset of diabetes in the US are high, 25% to 40%, and sadly, have increased over the past 3 years (Diabetes 2010: 59 Supplement 1: A79, abstract 299), perhaps due to higher health insurance costs and more difficult economic times for many Americans. This likely reflects poor education of parents and physicians about the signs and symptoms of diabetes. A low level of awareness of the symptoms of diabetes, especially in young children, contributes to high rates of DKA and occurs in all countries. It is difficult to recognize symptoms of increased thirst and urination in young children who can relate few complaints. In addition, many of the signs of early diabetes and DKA, including vomiting, are often attributed to common, self-limited, intercurrent illnesses by parents and health care providers, leading to a further delay in diagnosis. Delay in diagnosis often results in more severe DKA; children can become comatose or die before diabetes is treated. The International Diabetes Federation and the International Society for Pediatric and Adolescent Diabetes have promoted a worldwide campaign to reduce the incidence of DKA at diagnosis. The impetus for this is the successful public awareness campaign that was conducted in Parma, Italy, from 1991 to 1998 (Diabetes Care 1999; 22:7-9). As a result of this campaign aimed at schools, families, and physicians, the DKA rate at diagnosis dropped from 78% to 12.5%. A toolbox that contains materials to be used with the media and in public venues to raise awareness is available at www.worlddiabetesday.org/dka. Health care providers and the general public can help raise awareness around the world that children can contract this serious disease and they can die from a delay in its diagnosis. Perhaps someday routine diabetes antibody screening at the time of the preschool physical examination will alert physicians and families to children at high risk for type 1 diabetes. Until then, working together during World Diabetes Month, November 2010, will enable us to focus the world on a simple message—No Child Should Die of Diabetes.