Journal of Diagnostics Concepts & Practice >
Progress in diagnosis and treatment of pediatric diabetes in China
Received date: 2024-08-26
Accepted date: 2024-10-08
Online published: 2025-02-25
The global incidence of type 1 diabetes mellitus (T1DM) in children and adolescents aged 0-19 years is about 1 211.9/10 million, with an incidence rate of 149.5/1 million person-years. In China, the incidence of T1DM in children and adolescents aged 0-19 years is about 56/1 million, with an incidence rate of 6.1/1 million person-years. The incidence of type 2 diabetes mellitus (T2DM) in children and adolescents has been rising annually. Epidemiological data shows that the incidence of T2DM among adolescents in the United States increased from 34/100 000 in 2001 to 46/100 000 in 2009 and to 67/100 000 in 2017. In China, the incidence of pediatric T2DM has also shown a significant upward trend, rising from 4.1/100 000 in 1995 to 10.0/100 000 in 2010. The diagnostic criteria for pediatric diabetes in China follow the standards set by the World Health Organization in 2019. Diabetes subtypes related to children include T1DM, T2DM, mixed-type diabetes, and other specific types of diabetes. The typical clinical manifestations of adult diabetes are polydipsia, polyuria, polyphagia, and weight loss (the ‘three P’s and one less’). However, in children with T1DM, these symptoms are more pronounced, while T2DM may present more subtly. Traditional treatment for T1DM primarily involves insulin therapy, but it cannot fundamentally address the issue of impaired pancreatic function. Preventing or delaying β-cell damage and protecting the remaining pancreatic function have become new research directions in T1DM treatment. In addition to traditional insulin therapy and lifestyle interventions, new treatments such as immunotherapy, artificial pancreas, and stem cell transplantation have shown promising clinical results. These advances not only provide new directions for the future treatment of diabetes but also have the potential to transform diabetes from an incurable disease into a treatable one.
PEI Zhou , LUO Feihong . Progress in diagnosis and treatment of pediatric diabetes in China[J]. Journal of Diagnostics Concepts & Practice, 2024 , 23(05) : 461 -466 . DOI: 10.16150/j.1671-2870.2024.05.001
[1] | DONG C, WU G, LI H, et al. Type 1 and type 2 diabetes mortality burden: Predictions for 2030 based on Bayesian age-period-cohort analysis of China and global mortality burden from 1990 to 2019[J]. J Diabetes Investig, 2024, 15(5):623-633. |
[2] | MOBASSERI M, SHIRMOHAMMADI M, AMIRI T, et al. Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis[J]. Health Promot Perspect, 2020, 10(2):98-115. |
[3] | LAWRENCE J M, DIVERS J, ISOM S, et al. Trends in prevalence of type 1 and type 2 diabetes in children and adolescents in the US, 2001-2017[J]. JAMA, 2021, 326(8):717-727. |
[4] | WU H, ZHONG J, YU M, et al. Incidence and time trends of type 2 diabetes mellitus in youth aged 5-19 years: a population-based registry in Zhejiang, China, 2007 to 2013 [J]. BMC Pediatr, 2017, 17(1):85. |
[5] | SHAH A S, ZEITLER P S, WONG J, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Type 2 diabetes in children and adolescents[J]. Pediatr Diabetes, 2022, 23(7):872-902. |
[6] | 中华医学会儿科学分会内分泌遗传代谢学组, 中华儿科杂志编辑委员会. 中国儿童1型糖尿病标准化诊断与治疗专家共识(2020版)[J]. 中华儿科杂志, 2020, 58(6):447-454. |
The Subspecialty Group of Endocrinologic, Hereditary and Metabolic Diseases, The Society of Pediatrics, Chinese Medical Association; the Editorial Board, Chinese Journal of Pediatrics. Expert consensus on the standardized diagnosis and management of type 1 diabetes mellitus in Chinese children (2020)[J]. Chin J Pediatr, 2020, 58(6):447-454. | |
[7] | 中华医学会儿科学分会内分泌遗传代谢学组. 儿童青少年2型糖尿病诊治中国专家共识[J]. 中华儿科杂志, 2017, 55(6):404-410. |
The Subspecialty Grou[ of Endocrinologic, Hereditary and Metabolic Diseases, the Society of Pediatrics, Chinese Medical Association. Type 2 diabetes in the child and adolescent: consensus in China[J]. Chin J Pediatr, 2017, 55(6):404-410. | |
[8] | BONNEFOND A, UNNIKRISHNAN R, DORIA A, et al. Monogenic diabetes[J]. Nat Rev Dis Primers, 2023, 9(1):12. |
[9] | URANO F. Wolfram syndrome: diagnosis, management, and treatment[J]. Curr Diab Rep, 2016, 16(1):6. |
[10] | BEN-SKOWRONEK I. IPEX syndrome: genetics and treatment options[J]. Genes (Basel), 2021, 12(3):323. |
[11] | 中华医学会儿科学分会内分泌遗传代谢学组. 儿童单基因糖尿病临床诊断与治疗专家共识[J]. 中华儿科杂志, 2019, 57(7):508-514. |
The Subspecialty Group of Endocrinological,Hereditary and Metabolic Disease, the Society of Pediatrics, Chinese Medical Association. Expert consensus on the diagnosis and management of monogenic diabetes in children and adolescents[J]. Chin J Pediatr, 2019, 57(7):508-514. | |
[12] | HEROLD K C, GITELMAN S E, EHLERS M R, et al.Teplizumab (anti-CD3 mAb) treatment preserves C-peptide responses in patients with new-onset type 1 diabetes in a randomized controlled trial: metabolic and immunologic features at baseline identify a subgroup of respon-ders[J]. Diabetes, 2013, 62(11):3766-3774. |
[13] | HEROLD K C, BUNDY B N, LONG S A, et al. An anti-CD3 antibody, teplizumab, in relatives at risk for type 1 diabetes[J]. N Engl J Med, 2019, 381(7):603-613. |
[14] | KEYMEULEN B, VAN MAURIK A, INMAN D, et al. A randomised, single-blind, placebo-controlled, dose-fin-ding safety and tolerability study of the anti-CD3 monoclonal antibody otelixizumab in new-onset type 1 diabetes[J]. Diabetologia, 2021, 64(2):313-324. |
[15] | HALLER M J, GITELMAN S E, GOTTLIEB P A, et al. Anti-thymocyte globulin/G-CSF treatment preserves β cell function in patients with established type 1 diabetes[J]. J Clin Invest, 2015, 125(1):448-455. |
[16] | LIN A, MACK J A, BRUGGEMAN B, et al. Low-dose ATG/GCSF in established type 1 diabetes: a five-year follow-up report[J]. Diabetes, 2021, 70(5):1123-1129. |
[17] | 陈双, 杨涛, 顾愹. 1型糖尿病的诊断与免疫治疗[J]. 国际内分泌代谢杂志, 2021, 41(6):578-582. |
CHEN S, YANG T, GU R. Diagnosis and immunotherapy of type 1 diabetes mellitus[J]. Int J Endocrinol Metab, 2021, 41(6):578-582. | |
[18] | ORBAN T, BUNDY B, BECKER D J, et al. Costimulation modulation with abatacept in patients with recent-onset type 1 diabetes: follow-up 1 year after cessation of treatment[J]. Diabetes Care, 2014, 37(4):1069-1075. |
[19] | RUSSELL W E, BUNDY B N, ANDERSON M S, et al. Abatacept for delay of type 1 diabetes progression in stage 1 relatives at risk: A randomized, double-masked, controlled trial[J]. Diabetes Care, 2023, 46(5):1005-1013. |
[20] | 黄玫, 张梅. 人工胰腺治疗1型糖尿病的临床研究进展[J]. 中华糖尿病杂志, 2023, 15(5):465-469. |
HUANG M, ZHANG M. Clinical research advances of artificial pancreas for type 1 diabetes mellitus[J]. Chin J Diab, 2023, 15(5):465-469. | |
[21] | WARE J, ALLEN J M, BOUGHTON C K, et al. Randomi-zed trial of closed-loop control in very young children with type 1 diabetes[J]. N Engl J Med, 2022, 386(3):209-219. |
[22] | LAKSHMAN R, BOUGHTON C, HOVORKA R. The changing landscape of automated insulin delivery in the management of type 1 diabetes[J]. Endocr Connect, 2023, 12(8):e230132. |
[23] | CASTELLANOS L E, BALLIRO C A, SHERWOOD J S, et al. Performance of the insulin-only ilet bionic pancreas and the bihormonal iLet using dasiglucagon in adults with type 1 diabetes in a home-use setting[J]. Diabetes Care, 2021, 44(6):e118-e120. |
[24] | TSOUKAS M A, MAJDPOUR D, YALE J F, et al. A fully artificial pancreas versus a hybrid artificial pancreas for type 1 diabetes: a single-centre, open-label, randomised controlled, crossover, non-inferiority trial[J]. Lancet Digit Health, 2021, 3(11):e723-e732. |
[25] | MAJDPOUR D, TSOUKAS M A, YALE J F, et al. Fully automated artificial pancreas for adults with type 1 diabetes using multiple hormones: exploratory experiments[J]. Can J Diabetes, 2021, 45(8):734-742. |
[26] | MADANI S, AMANZADI M, AGHAYAN H R, et al. Investigating the safety and efficacy of hematopoietic and mesenchymal stem cell transplantation for treatment of T1DM: a systematic review and meta-analysis[J]. Syst Rev, 2022, 11(1):82. |
[27] | 王树森, 蔡湘衡. 临床胰岛移植的发展趋势[J]. 中华器官移植杂志, 2023, 44(6):327-333. |
WANG S S, CAI X H. Trends in clinical islet transplantation[J]. Chin J Organ Transplant, 2023, 44(6):327-333. | |
[28] | 杜媛媛, 邓宏魁. 1型糖尿病治疗的新希望:人化学诱导多能干细胞衍生胰岛细胞移植[J]. 中华内科杂志, 2023, 62(9):1043-1045. |
DU Y Y, DENG H K. A novel approach for the treatment of type 1 diabetes mellitus: transplantation of pancreatic islets derived from human chemically induced pluripotent stem cells[J]. Chin J Int Med, 2023, 62(9):1043-1045. | |
[29] | WANG S, DU Y, ZHANG B, et al. Transplantation of chemically induced pluripotent stem-cell-derived islets under abdominal anterior rectus sheath in a type 1 diabetes patient[J]. Cell, 2024, 187(22):6152-6164 |
[30] | WU J, LI T, GUO M, et al. Treating a type 2 diabetic patient with impaired pancreatic islet function by personali-zed endoderm stem cell-derived islet tissue[J]. Cell Discov, 2024, 10(1):45. |
[31] | YUAN X, WANG R, HAN B, et al. Functional and metabolic alterations of gut microbiota in children with new-onset type 1 diabetes[J]. Nat Commun, 2022, 13(1):6356. |
[32] | DE GROOT P, NIKOLIC T, PELLEGRINI S, et al. Faecal microbiota transplantation halts progression of human new-onset type 1 diabetes in a randomised controlled trial[J]. Gut, 2021, 70(1):92-105. |
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