Type 1 diabetes (T1D) is a major health concern globally. It affects people of all ages, such as infants, adolescents, adults and the elderly. T1D is considered an autoimmune condition whereby the immune system attacks the islet cells located within the pancreas, which interferes with normal insulin production (Borchers et al., 2010.). Much research has been conducted to help treat T1D in pediatrics, such as proper nutrition, body exercise and behavioral changes (Chiang et al., 2018.). However, there are existing gaps in this issue. Various databases such as PubMed Central and Science Direct have addressed the issue of T1D in pediatrics. This paper seeks to address the methods used and ongoing research in T1D and the high cost of T1D treatment and management in pediatrics in the United States.
Many studies have been conducted to come up with solutions to prevent and treat children suffering from T1D. A study conducted to show the prevalence of T1D in pediatrics and youths below 19 years showed a 21.1% rise in cases between 2001 and 2009 (Chiang et al., 2018.). The research showed that all races are at high risk, except the American Indians. The number of pediatric T1D patients continues to grow as days goes by. T1D diabetes in pediatrics can be symptomatic or asymptomatic.
Insulin therapy is vital for the survival of type 1 diabetic pediatrics. Insulin delivery systems have been developed to help mimic normal insulin patterns within the body (Chiang et al., 2018.). The insulin infusion pump therapy has been used for the treatment of type 1 diabetic patients. Continuous Subcutaneous Insulin Infusion (CSII) has a significant impact on pediatric patients with poor glucose metabolism. CSII has high efficacy in the initial treatment of T1D (Dovc et al., 2014). This mode of treatment has increased the quality of life and has reduced the following: Rates of hypoglycemia, glycated hemoglobin (HbAIc) levels and hypoglycemia phobia. Continuous glucose monitoring devices in insulin administration have significantly reduced hypoglycemia in pediatric patients.
Research is being conducted to apply telehealth to take care of children suffering from T1D in the United States (Fogel & Raymond, 2020.). Telehealth has been implemented due to an uneven distribution of diabetic endocrinologists compared to the increased number of diabetic pediatrics in The States. The number of pediatric patients who can access an endocrinologist within 20 miles in the USA is 64.1%, and this poses a significant problem to pediatrics in rural areas (Fogel & Raymond, 2020.). Telehealth is cost-effective in the improvement pediatric health. Since diabetes requires several medical appointments to monitor glucose levels, telehealth can be used to access pediatric patients in rural areas easily. The care team can form access to the local laboratories or pharmacies where the patients can be monitored with ease. The essential clinical information such as HbAIc levels and data generated from various diabetes devices such as glucose monitors and glucometers can be obtained from a local laboratory or pharmacy and downloaded and shared to the care team via the internet. Various telehealth devices to be used to conduct physical examinations virtually, such as otoscopes, are under assessment.
Research is still being conducted to evaluate the effectiveness of adjunctive therapies in the treatment of pediatric T1D in the USA. Adjunctive therapies mainly aim to solve the problem of insulin resistance (Chiang et al., 2018.). They are effective in the cases of obesity and adolescents. Endocrinologists are assessing the importance of adding metformin to insulin to control the glycemic levels in overweight pediatrics suffering from T1D. In combination with insulin, Pramlintide has proved to be effective in controlling glucose levels in type 1 diabetes patients. Pramlintide plays a role in the suppression of glucagon secretion delay of stomach emptying. However, the efficacy of pramlintide in pediatric patients is still being studied.
Lifestyle management is essential in T1D pediatric patients. It plays a significant role in preventing cardiovascular disease, control of glucose levels, and maintenance of health. Proper nutrition and exercise are essential in T1D pediatric patients (Chiang et al., 2018.). The carbohydrate intake should be monitored to achieve glycemic control. The dietitian should continually assess the food preferences and eating habits of the T1D pediatric patients. Carbohydrate intake from fruits, whole grains, vegetables, legumes, and dairy products should be preferred. The amount of saturated fats consumed should be minimized (Chiang et al., 2018.). Various strategies to prevent low glycemic levels during exercise include eating snacks before a workout, increasing carbohydrate consumption, and reducing the insulin dosage. Pre and post-exercise glucose levels should always be monitored to prevent hypoglycemia and hyperglycemia in T1D children.
Behavior should also be considered during the management of T1D. A good behavioral lifestyle helps maintain blood sugar at suitable levels (Chiang et al., 2018.). Family issues and psychological stress can negatively impact the management of T1D in pediatrics. Social adjustments at school and home have proved to be very helpful in managing T1D in pediatric patients. Children from the age of 8 should be assessed for diabetes-related and generic stress (Chiang et al., 2018.). Therefore, family care should be provided to T1D adolescents.
Both blood and urine have been monitored for ketone levels in severe hyperglycemia in T1D pediatric patients to check for the effectiveness of insulin therapy. Ketone levels are also tested when the pediatric patients present with symptoms such as vomiting, fever, nausea and abdominal pain (Chiang et al., 2018.). Ketone levels guide the healthcare provider on whether to change insulin therapy, or urgent hospital admission is required. However, ketones may be present in urine due to fasting, and their presence does not always indicate acute illness.
As insulin therapy has been effective in managing T1D in pediatrics, the cost of management is relatively high. The cost of treatment varies based on insulin regimen and dosage and the devices used. A study showed that the annual estimated treatment cost per person in the USA was 4730 dollars (Ying et al., 2010.). T1D pediatric patients are also at a high risk of developing complications that require hospitalization accounting for more costs. The annual cost of intensive care, which comprises an insulin regimen and varied injections, was estimated to be 5800 dollars, which was three times the conventional therapy, which comprises two injections daily. Therefore, T1D pediatric patients face a significant financial cost.
In conclusion, insulin therapy is effective in T1D treatment in pediatric patients in the USA. Research in telehealth devices and adjunctive therapies will fill the existing gaps and provide effective T1D treatment in pediatrics. Lifestyle and behavioral modifications are necessary for the management of TID in pediatrics patients. The level of ketones in blood and urine should also be checked to assess the effectiveness of insulin therapy. The cost of treatment of T1D in pediatric patients is also a major challenge, and it should also be subsidized to make it affordable.
References
Borchers, A. T., Uibo, R., & Gershwin, M. (2010). The geoepidemiology of type 1 diabetes. Autoimmunity Reviews, 9(5), A355-A365. https://doi.org/10.1016/j.autrev.2009.12.003
Chiang, J. L., Maahs, D. M., Garvey, K. C., Hood, K. K., Laffel, L. M., Weinzimer, S. A., Wolfsdorf, J. I., & Schatz, D. (2018). Type 1 diabetes in children and adolescents: A position statement by the American Diabetes Association. Diabetes Care, 41(9), 2026-2044. https://doi.org/10.2337/dci18-0023
Dovc, K., Telic, S., Lusa, L., Bratanic, N., Tansec, M., & Kotnic, P. et al. (2014). Improved Metabolic Control in Pediatric Patients with Type 1 Diabetes: A Nationwide Prospective 12-Year Time Trends Analysis. Diabetes Technology & Therapeutics, 6(1), 33-38. https://doi.org/10.1089/dia.2013.0182
Fogel, J. L., & Raymond, J. K. (2020). Implementing Telehealth in pediatric type 1 diabetes mellitus. Pediatric Clinics of North America, 67(4), 661-664. https://doi.org/10.1016/j.pcl.2020.04.009
Ying, A. K., Lairson, D. R., Giardino, A. P., Bondy, M. L., Zaheer, I., Haymond, M. W., & Heptulla, R. A. (2010). Predictors of direct costs of diabetes care in pediatric patients with type 1 diabetes. Pediatric Diabetes, 12(3pt1), 177-182. https://doi.org/10.1111/j.1399-5448.2010.00680.x
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