Managing diabetes in childhood and adolescence.

OBJECTIVE: To describe management of children's and adolescents' diabetes outlining standards of care compatible with current clinical practice. QUALITY OF EVIDENCE: MEDLINE was searched using specified MeSH headings. Bibliographies of selected articles were used to find additional pertinent articles. Preference was given to randomized controlled trials, clinical practice guidelines, consensus statements, and task force recommendations. We also cite reviews of current practice regarding pediatric diabetes. MAIN MESSAGE: Managing children with diabetes presents a difficult challenge to parents and their advisors. Achieving good diabetic control is impossible unless parents are properly instructed in practical management of the disease. Children with diabetes should be managed quite differently from adults in several respects. Avoiding hypoglycemia is most important, particularly for preschool children. Higher target blood glucose levels than would be accepted for adults are both justifiable and necessary for preschool children. Controlling children's diabetes depends as much on personal factors and family adjustment as it does on insulin, food plans, and exercise.
CONCLUSION: Diabetes mellitus is difficult to manage at any age. Managing children's diabetes successfully requires continuous education and encouragement of parents and children. Pediatric diabetes care teams and family physicians play a vital role in encouraging children to control their disease while participating fully in normal childhood activities.