Diabetes Is Different for Children
Joran is a normal 16-month-old boy who lives in a country in the World Health Organization (WHO) top 20 for healthcare services. He has been thirsty and restless, has seemed hungry for three days, and one night develops a fever. He is increasingly unwell and starts vomiting. However, he is eager to drink and his diapers are still wet. His mother notices that Joran is acting unusually and calls the emergency services. The nurse on duty for the telephone triage follows her protocols and notes down the signs and symptoms that Joran’s mother tells her about. She concludes that: ‘If he is still drinking and wetting his diapers, there is no need for a visit to the clinic. This must be a case of gastroenteritis. A lot of kids have it right now.’ The fact that he seems to be acting unusually is explained as ‘being sick.’ The next morning, Joran’s mother finds her baby son in a coma. He is rushed to hospital, where type 1 diabetes with diabetic ketoacidosis (DKA) and seve e dehydration is diagnosed. Treatment is complicated by cerebral edema. Joran survives, but with severe brain damage.

For those of us working in pediatric diabetes, Joran’s is not an altogether unfamiliar story, and speaks clearly of a need for greater awareness of diabetes in children among the professional medical community. In 2007, a working group of international experts on diabetes in children and adolescents collated the available literature on childhood diabetes and developed a Diabetes in Youth Charter. The charter shows that diabetes in children and its treatment are markedly different from in the adult population. It shows that diabetes in children is increasing at a global rate that merits concern. It shows that good care is possible, but is not widely available, and that the problems in diabetes care are often connected to psychosocial attitudes and needs. The charter also shows that the socioeconomic impact of children and young adults developing diabetes before their productive years i immense, and should be a motivating force for adequate diagnosis and improvements to care. The need for greater awareness of diabetes in children and the need for change drive the World Diabetes Day 2008 campaign.

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