Diabetes Management in Pediatric Populations: A Literature Synthesis

Diabetes mellitus has been categorized as one of the most prevalent childhood chronic illnesses, with a constantly increasing incidence rate that raises various improvements to the quality of life, treatment management, and family involvement (Abdelhameed et al., 2024; American Diabetes Association, 2021; ElSayed et al., 2022). This paper offers a review of the literature on pediatric diabetes, focusing on morbidity and prevalence and diagnostic methods, strategies of management, and psychosocial factors in pediatric diabetes: Diabetes Management in Pediatric Populations: A Literature Synthesis.

Prevalence and Diagnosis of Pediatric Diabetes

Modern diabetes is inevitably connected with socioeconomic and lifestyle characteristics, and pediatric diabetes is no exception. In one study, Abdelhameed et al. (2024) found that members of the inner city’s ethnic minority and low-income residents suffer more from type 2 diabetes due to restricted access to healthcare services. Buttermore et al. (2021) extend these trends to dietary and physical activity changes and describe rates increasing most dramatically in underserved populations. Screening tests, including fasting plasma glucose, HbA1c, and the OGTT, are crucial; however, they are variably available (Los & Wilt, 2023).

The American Diabetes Association (2021) also states that early detection is enhanced by routine screenings as well as in high-risk groups to enhance conformity. ElSayed et al. (2022) stress early diagnosis to avert complications, while Tillotson et al. (2023) stress conducting mass, community-based screening, especially targeting the youth. Likewise, Serbis et al. (2021) and Sundberg et al. (2022) emphasize prevention through education and child-appropriate screening methods.

However, access differences still exist, as evidenced by Yau Sperling (2021), and diagnostic capacity is still scarce in developing regions. From these stimuli, it becomes apparent that efficient and universal screening programs must be made available to high-risk populations.

Treatment Protocols and Innovations

Effective treatment of pediatric diabetes requires a combination of lifestyle modifications, pharmacotherapy, and technological aids. The American Diabetes Association (ADA) standards of care (American Diabetes Association, 2021) and the updated guidelines by ElSayed et al. (2022) promote personalized treatment plans that include CGM and insulin pumps, especially for type 1 diabetes patients. CGMs provide real-time monitoring, improving glucose control and reducing the need for frequent testing.

However, limited access to these devices, particularly in lower-income settings, hinders equitable outcomes. Abdelhameed et al. (2024) highlight these disparities, suggesting the need for broader policy support to make these technologies more widely available.

Type 1 and type 2 diabetes mellitus are different in regards to pharmacologic therapy in children. Insulin still stands as the chief method of treatment for type 1 diabetes. Still, Pinhas-Hamiel and Zeitler (2023) suggest the use of metformin when handling type 2 diabetes accompanied by modification of diets and physical activity. Tillotson et al. (2023) support these aspects, stating that diet and physical activity are fundamental in type 2 diabetes care.

Moreover, school and community-related interventions on lifestyle changes to prevent and manage diabetes in vulnerable groups are suggested by Serbis et al. (2021). However, despite offering equally or even better outcomes, these new drugs—GLP-1 receptor agonists and S GLT 2 inhibitors—are limited in their use in children due to regulatory restrictions and affordability.

Psychosocial Impacts and Family Dynamics

The psychosocial effects go beyond the child with the chronic condition; they affect the whole family and the well-being of the entire family. Madrigal et al. (2020) explore how type 1 diabetes affects family stress and demonstrate how the disease can cause fluctuations in family stability, sibling rivalry, and increased role strain for caregivers.

These findings are similar to other works that emphasize that the goal of combating non-adherence is to focus on psychological factors to improve adherence to treatment regimens and quality of life (Monaghan et al., 2022). Cognitive behavioral therapy (CBT) and family intervention procedures have received promising results regarding the patient’s status and the overall family state, especially in handling stress related to pediatric diabetes (Monaghan et al., 2022).

ADA standards and the literature published recently underline the importance of psychological assistance in the treatment of childhood diabetes. Patients with diabetes also have psychological disorders; the integration of behavioral health in the treatment plan targets the dual medical and psychological problems of the patient and family (American Diabetes Association, 2021).

Sundberg et al. (2022) also explain the importance of psychosocial care and reflect on the necessary elements of diabetes: the child’s development should also be a factor in diabetes management, including both physical and psychological aspects. These guidelines evoke an essence of integrated care that is emphasized by the involvement of caregivers and assessments in treating diabetes in young patients.

Technological Advancements and Accessibility Challenges

Technology has also added new features in the management of diabetes with continuous glucose monitoring devices, insulin pumps, and artificial pancreas systems, all improving glycemic control and ease of use (Yau & Sperling, 2021; Los & Wilt, 2023). For example, CGMs offer timely information on the patient’s blood glucose level, thus sparing the patient with frequent use of a lancet and giving accurate measurements for insulin administration. Also, closed-loop hybrid systems operate insulin bolus, depend on the CGM data, and improve the results of diabetes management for children (ElSayed et al., 2022).

However, such technologies are not easily accessible, and the level of economic development strongly influences their availability. As stated by Los and Wilt (2023), new diabetes technology-guided treatments remain unavailable to low-income families and, therefore, significantly differ from the experiences of other patient populations.

In this regard, Abdelhameed et al. (2024) also link children from deprived backgrounds to increased disease risk and or/compromised opportunities to obtain good quality health care. Elements of policies that focus on enhancing the availability of these resources are invaluable when it comes to the elimination of such disparity so that all children can benefit from the role of advanced technology in the management of diabetes.

Moreover, Sundberg et al.’s (2022) study reveals that healthcare providers, notably pediatric nurses, need education advocacy to incorporate technology into treatments. Policy advocacy, as well as addressing all families’ questions, frustrations, and concerns about devices and resources, lie squarely in the realm of nursing. In addition, it contributes to the enhancement of diabetes management and thus could be used to overcome the disparity between evidence-based practice and real-life application.

Controversies and Conflicting Findings

Paradoxical attitudes within the literature include the approach to the management of pediatric diabetes, specifically pharmacologic and non-pharmacologic methodologies. Although some authors consider lifestyle modification the cornerstone of type 2 diabetes management, others support the early use of antidiabetic drugs to avoid complications.

In particular, Tillotson et al. (2023) note that the best way is non-pharmacological, emphasizing that the modifications of diet and exercise provide the main protection. Nevertheless, Pinhas-Hamiel and Zeitler (2023) emphasize the role of pharmacologic treatment, specifically with metformin, for metabolic management in children because of the limitation of lifestyle modification alone.

Moreover, Monaghan et al. (2022) propose using pharmacotherapy together with behavioral therapy as the only dual-action strategy to enhance both glycemic outcomes and patients’ compliance. However, in their review of treatments for type 2 diabetes, Los and Wilt (2023) suggest that family-based support and education are of the highest priority because non-pharmacologic treatments like these are safe and feasible. Thus, there is still a necessity for more investigation of how RAS management could be dependent on certain characteristics of the patient.

Moreover, broad technological advances like CGM and closed-loop systems add other degrees of decision-making in diabetes care. Even though Yau and Sperling (2021 argue that CGM is effective due to its accuracy in tracking glucose levels, ElSayed et al. (2022) note that there can be issues with access, which could be an issue for underserved populations and a concern of inequality in access to advance care.

These differences in beliefs of treatment underscore the need for patient-centered care that encompasses the biological, psychosocial, and economic susceptibilities of a pediatric patient. The spectrum of care delivery, innovation, and development can help clinicians deliver better, integrated self-care diabetes care to enhance the quality of life for children with diabetes.

References

Abdelhameed, F., Giuffrida, A., Thorp, B., Moorthy, M. K., & Gevers, E. F. (2024). Exploring the surge in paediatric type 2 diabetes in an inner-city London centre—A Decade-Long Analysis of Incidence, Outcomes, and Transition. Children (Basel), 11(2), 173–173. https://doi.org/10.3390/children11020173

American Diabetes Association. (2021). Children and adolescents: Standards of medical care in diabetes—2022. Diabetes Care, 45(Supplement_1), S208–S231. https://doi.org/10.2337/dc22-s014

Buttermore, E., Campanella, V., & Priefer, R. (2021). The increasing trend of type 2 diabetes in youth: An overview. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 15(5), 102253. https://doi.org/10.1016/j.dsx.2021.102253

ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Hilliard, M. E., Isaacs, D., Johnson, E. L., Kahan, S., Khunti, K., Leon, J., Lyons, S. K., Perry, M. L., Prahalad, P., Pratley, R. E., Seley, J. J., Stanton, R. C., & Gabbay, R. A. (2022). 14. Children and adolescents: Standards of care in diabetes—2023. Diabetes Care, 46(Supplement_1), S230–S253. https://doi.org/10.2337/dc23-s014

Los, E., & Wilt, A. S. (2023, June 26). Diabetes mellitus type 1 in children. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK441918/

Madrigal, M. A., López, M., Sánchez, A., Cao, M. J., Castro, M. J., & Jiménez, J. M. (2020). Type 1 diabetes mellitus in pediatric patients and its impact on relationships in the family environment. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Volume 13(78), 4973–4980. https://doi.org/10.2147/dmso.s281949

Monaghan, M., Bryant, B. L., Inverso, H., Moore, H. R., & Streisand, R. (2022). Young children with type 1 diabetes: Recent advances in behavioral research. Current Diabetes Reports, 22(6). https://doi.org/10.1007/s11892-022-01465-0

Pinhas-Hamiel, O., & Zeitler, P. (2023, November 7). Type 2 diabetes in children and adolescents- A focus on diagnosis and treatment (K. R. Feingold, B. Anawalt, M. R. Blackman, A. Boyce, G. Chrousos, E. Corpas, W. W. de Herder, K. Dhatariya, K. Dungan, J. Hofland, S. Kalra, G. Kaltsas, N. Kapoor, C. Koch, P. Kopp, M. Korbonits, C. S. Kovacs, W. Kuohung, B. Laferrère, & M. Levy, Eds.). PubMed; MDText.com, Inc. https://www.ncbi.nlm.nih.gov/books/NBK597439/

Serbis, A., Giapros, V., Kotanidou, E. P., Galli-Tsinopoulou, A., & Siomou, E. (2021). Diagnosis, treatment, and prevention of type 2 diabetes mellitus in children and adolescents. World Journal of Diabetes, 12(4), 344–365. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040084/

Sundberg, F., deBeaufort, C., Krogvold, L., Patton, S., Piloya, T., Smart, C., Van Name, M., Weissberg‐Benchell, J., Silva, J., & diMeglio, L. A. (2022). ISPAD Clinical Practice Consensus Guidelines 2022: Managing diabetes in preschoolers. Pediatric Diabetes, 23(8), 1496–1511. https://doi.org/10.1111/pedi.13427

Tillotson, C. V., Bowden, S. A., & Boktor, S. W. (2023, November 12). Pediatric type 2 diabetes mellitus. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK431046/

Yau, M., & Sperling, M. (2021, June 28). Treatment of diabetes mellitus in children and adolescents (K. R. Feingold, B. Anawalt, A. Boyce, G. Chrousos, W. W. de Herder, K. Dungan, A. Grossman, J. M. Hershman, J. Hofland, G. Kaltsas, C. Koch, P. Kopp, M. Korbonits, R. McLachlan, J. E. Morley, M. New, J. Purnell, F. Singer, C. A. Stratakis, & D. L. Trence, Eds.). PubMed; MDText.com, Inc. https://www.ncbi.nlm.nih.gov/books/NBK279087/

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Guidelines for Literature Synthesis Assignment

The student should review all the resources provided in this module prior to writing the Literature Synthesis.  Begin by organizing your synthesis based on your literature findings. Identify themes or common findings and your paper can focus on these as your write it. Below are some general tips to use that may be helpful.

Requirements:

1. Formal paper, APA format required, 3-4 pages in length, not including title page and reference list.

 

2. Title page required

 

3. Introduction- first paragraph (no heading), short paragraph, sample format:

 

_____________  ranks as the _________ cause of death in the United States (author1, date; author5, date;  author 9, date).   Chronic __________ decreases quality of life, _________ , _________ (author6, author 7).   This paper presents a synthesis of literature reviewed on your topic.

 

4. Compares/contrasts articles used in annotated bibliography. Concepts used should be evident and addressed in separate paragraphs.  Group authors with similar statements together.

 

1. Identifies which articles are primary research (conducted by authors), a summary of research done by others (includes meta-analyzes), published clinical guidelines or evidence based practice focused.
2. Concepts used to compare/contrast articles are evident. Concepts may include content related to genomics, causes, diagnosis, recommended treatment, prognosis, and long term approaches to care.  Concepts will depend upon your topic.
3. Identifies conflicting or controversial information reported in articles.

Sample format: Research indicated there are a number of approaches to treating ___________. One study by Williams et al.(2020) described numerous treatments using a retrospective review of 1,500 hospitalized adult patients and included various treatments and success rates.  A study specifically focusing on comparing two treatments (name these) across 400 patients identified the best treatment as ______ (Miller & Smith, 2019). Another study reported the use of an experimental treatment and provided contrast to the most popular treatment (Adams et al., 2018). All the methods yielded effective results as noted by each study, but the standard of practice seems to offer slightly different treatment standards.

 

5. Address all articles included in your annotated bibliography and include a reference list in APA format.

 

You will use the literature synthesis to develop the abstract/poster for your presentation in NSG 6697.