Type 1 Diabetes in Children and Adolescents

Diabetes mellitus is a lifelong disorder characterized by alteration in the metabolism of glucose and other energy-yielding fuels due to an absolute or relative insufficiency of insulin. This lack of insulin plays a primary role in the metabolic derangements linked to diabetes, including hyperglycemia. Hyperglycemia in turn plays a key role in the microvascular and macrovascular complications of diabetes. Metabolic control of diabetes that is as close to normal as possible should be achieved as early in the course of the disease as possible in order to prevent or delay the development of diabetes-related complications. Advanced diabetes technologies, such as real-time continuous glucose monitors (CGMs), new and improved insulin pumps, and semiautomated integrated insulin pump/glucose sensor systems or hybrid closed-loop systems, have changed the landscape of type 1 diabetes (T1D) management in the past two decades. As described in this chapter, optimal control of T1D nevertheless remains challenging in pediatric patients despite these therapeutic advancements.