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- Is there a difference in clinical profile of children with T1DM who have paren-
tal history of T2DM?
Children with T1DM who have parental history of T2DM have late onset
of disease (17.2 vs. 16.1 years), increased prevalence of metabolic syn-
drome (44 vs. 38 %), and higher HbA1c and triglycerides and require
greater dose of insulin as compared to children with T1DM who do not
have parental history of T2DM. This suggests that insulin resistance
(familial) can modulate the phenotypic expression of T1DM in children
who have parental history of T2DM.- What is the risk of developing T1DM in an offspring of a couple with T1DM?
Only 10–15 % of patients with T1DM have a family history of T1DM. The risk
of developing T1DM in an offspring is higher, if father has T1DM as compared
to mother (4.6 % vs. 2 %); however, the risk is 10 % if both parents have
T1DM. The risk is approximately 5 % if any sibling has T1DM. If a parent and
one sibling have the disease, the risk of developing T1DM in the other sibling
is 30 %. The concordance rate for occurrence of T1DM in identical twins is
30–50 %, while in dizygotic twins, it is 6 %.- What are the treatment targets in patients with T1DM for children and
adolescents?
The treatment targets in patients with T1DM for children and adolescents are
summarized in the table given below.Parameters Treatment targets
Blood
glucoseaPre-meals: 90–130 mg/dl Bedtime: 90–150 mg/dlHbA1Cb <7.5 %
Blood
pressure<90th percentile for age, sex, and heightLipids LDL-C <100 mg/dL
aPostprandial blood glucose should be measured if there is a discrepancy between pre-meal glu-
cose values and HbA1C
bHbA1c <7 % should be targeted if can be achieved without excessive risk of hypoglycemia. The
treatment targets in young patients with T2DM are similar to T1DM in children and adolescents;
however; the HbA1c target <7 % seems to be reasonable in young patients with T2DM
- What are the treatment modalities available for patients with T1DM?
Insulin is the mainstay of treatment for T1DM. Oral antidiabetic drugs have
been used as an adjunct to insulin therapy with limited benefits. The treatment12 Diabetes in the Young