Diabetes mellitus involves an absolute or relative deficiency of insulin secretion and peripheral insulin resistance, causing hyperglycemia. Early symptoms are related to hyperglycemia and include polydipsia, polyphagia, polyuria, and unintended weight loss. Diagnosis is by measuring plasma glucose levels and autoantibodies. Treatment depends on type but includes medications that reduce blood glucose levels, diet, and exercise.
(See also Diabetes Mellitus in adults.)
Types of Diabetes in Children and Adolescents
Type 1 diabetes is primarily characterized by inadequate insulin production due to autoimmune destruction of pancreatic beta cells. Type 1 diabetes is the most common type in children.
Type 2 diabetes is primarily characterized by insulin resistance and obesity. Rising prevalence of childhood obesity has led to an increase in the incidence of childhood type 2 diabetes, and an increase in the proportion of type 2 relative to type 1 diabetes diagnoses in children (1, 2) (see obesity in children). Type 2 diabetes is typically diagnosed in early adolescence with onset of puberty, when insulin resistance naturally increases and there is rapid growth and pubertal changes.
Most patients are categorized as having type 1 or type 2 diabetes, and this distinction is used to guide treatment. Classification is based on clinical history (age, family history, body habitus), presentation, and laboratory studies, including antibodies. However, this classification system does not fully capture the clinical heterogeneity of patients, and some patients cannot clearly be classified as having type 1 or type 2 diabetes at diagnosis. In both types 1 and 2, genetic and environmental factors can result in the progressive loss of beta-cell function that results in hyperglycemia. (see table ). There is, however, significant overlap between type 1 and type 2 diabetes. Terms that describe the age of onset (juvenile or adult) or type of treatment (insulin-dependent or non–insulin-dependent) are not used because of overlap in age groups and treatments between disease types.
Prediabetes is impaired glucose regulation resulting in higher than normal postprandial glucose levels after eating but that do not meet criteria for diabetes. Prediabetes is associated with the metabolic syndrome (impaired glucose regulation, dyslipidemia, hypertension, obesity). Lifestyle changes such as improving diet, increasing physical activity, and weight management are critical. Early intervention can often prevent or delay the onset of diabetes in adults, but in children, the evidence is largely circumstantial and recommendations are based on adult studies or proxy measures such as weight loss (3, 4).
Monogenic forms of diabetes, are not considered type 1 or type 2 and are uncommon (5). Monogenic forms are caused by genetic defects affecting beta-cell function, insulin action, or mitochondrial DNA. Monogenic forms include neonatal diabetes mellitus—onset before 6 months of age—and maturity-onset diabetes of the young (MODY)—onset typically in adolescence or early adulthood. Together, they make up approximately1 to 4% of pediatric diabetes and often involve single-gene mutations.
Other types of diabetes include cystic fibrosis-related diabetes (CFRD), drug-induced diabetes (glucocorticoids, antipsychotics, immunosuppressants), endocrinopathies with excess counter-regulatory hormones, and diabetes caused by disorders of the exocrine pancreas (eg, chronic pancreatitis, pancreatectomy).
Types of diabetes references
1. Gesuita R, Eckert AJ, Besançon S, et al. Frequency and clinical characteristics of children and young people with type 2 diabetes at diagnosis from five world regions between 2012 and 2021: data from the SWEET Registry. Diabetologia. 2025;68(1):82-93. doi:10.1007/s00125-024-06283-5
2. Wagenknecht LE, Lawrence JM, Isom S, et al. Trends in incidence of youth-onset type 1 and type 2 diabetes in the USA, 2002-18: results from the population-based SEARCH for Diabetes in Youth study. Lancet Diabetes Endocrinol. 2023;11(4):242-250. doi:10.1016/S2213-8587(23)00025-6
3. Neyman A, Hannon TS; COMMITTEE ON NUTRITION. Low-Carbohydrate Diets in Children and Adolescents With or at Risk for Diabetes. Pediatrics. 2023;152(4):e2023063755. doi:10.1542/peds.2023-063755
4. US Preventive Services Task Force, Mangione CM, Barry MJ, et al. Screening for Prediabetes and Type 2 Diabetes in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;328(10):963-967. doi:10.1001/jama.2022.14543
5. American Diabetes Association Professional Practice Committee. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S27-S49. doi:10.2337/dc25-S002
Epidemiology of Diabetes in Children and Adolescents
Both type 1 and type 2 diabetes are increasing in prevalence. In the Unites States, the prevalence of type 1 diabetes in children up to age 19 years increased from 1.48 to 2.15 per 1000, and the prevalence of type 2 diabetes from 0.34 to 0.67 per 1000 from 2001 to 2017 (1). Worldwide, the estimated incidence rate of diabetes (all types) in children up to age 15 years increased from 9.3 to 11.6 per 100,000 population from 1990 to 2019, corresponding to about 227,000 new cases of diabetes in children in 2019 (2).
Despite diabetes technology that improves quality of care and glycemic control, disparities exist. Race, ethnicity, and social determinants of health (eg, socioeconomic status, neighborhood and physical environment, food environment, health care access, social context) are associated with the degree of glycemic control in children with diabetes (3, 4). In the United States, children who are White or non-Hispanic have a lower rate of complications and adverse outcomes caused by poor glycemic control.
Epidemiology references
1. Lawrence JM, Divers J, Isom S, et al. Trends in Prevalence of Type 1 and Type 2 Diabetes in Children and Adolescents in the US, 2001-2017. JAMA. 2021;326(8):717-727. doi:10.1001/jama.2021.11165
2. Zhang K, Kan C, Han F, et al. Global, Regional, and National Epidemiology of Diabetes in Children From 1990 to 2019. JAMA Pediatr. 2023;177(8):837-846. doi:10.1001/jamapediatrics.2023.2029
3. Kahkoska AR, Pokaprakarn T, Alexander GR, et al: The Impact of Racial and Ethnic Health Disparities in Diabetes Management on Clinical Outcomes: A Reinforcement Learning Analysis of Health Inequity Among Youth and Young Adults in the SEARCH for Diabetes in Youth Study. Diabetes Care. 45(1):108-118, 2022. doi: 10.2337/dc21-0496
4. Redondo MJ, Libman I, Cheng P, et al: Racial/Ethnic Minority Youth With Recent-Onset Type 1 Diabetes Have Poor Prognostic Factors. Diabetes Care. 41(5):1017-1024, 2018. doi: 10.2337/dc17-2335
Symptoms and Signs of Diabetes in Children and Adolescents
In type 1 diabetes, initial manifestations vary from asymptomatic hyperglycemia to life-threatening diabetic ketoacidosis. Most commonly, children present with symptomatic hyperglycemia without acidosis, with several days to weeks of increased urinary frequency, polyuria, polydipsia, and enuresis. Children may also have unintentional weight loss. For more detail, see Type 1 Diabetes in Children and Adolescents.
In type 2 diabetes, the clinical presentation varies widely. Children are often asymptomatic or minimally symptomatic, and their condition may be detected only on routine testing. However, some children will have symptomatic hyperglycemia, hyperglycemic hyperosmolar state or diabetic ketoacidosis. For more detail, see Type 2 Diabetes in Children and Adolescents.
Diagnosis of Diabetes in Children and Adolescents
Fasting plasma glucose level ≥ 126 mg/dL (≥ 7.0 mmol/L)
Random glucose level ≥ 200 mg/dL ( ≥ 11.1 mmol/L)
Glycosylated hemoglobin (HbA1C) ≥ 6.5% (≥ 48 mmol/mol)
Two-hour oral glucose tolerance test ≥ 200 mg/dL ( ≥ 11.1 mmol/L)
Determination of diabetes type (eg, type 1, type 2, monogenic)
Diagnostic criteria for diabetes
Diagnosis of diabetes and prediabetes is similar to that in adults, typically using specific thresholds for fasting or random plasma glucose levels and/or HbA1C level (see table ). Diabetes mellitus is suggested by typical symptoms and signs of hyperglycemia and confirmed by measurement of plasma glucose ≥ 200 mg/dL (≥ 11.1 mmol/L). It is often detected through screening. Any abnormal result should be confirmed with a second test.
Diabetes is diagnosed when one of the following is present (1, 2):
Glycosylated hemoglobin (HbA1C) ≥ 6.5% (≥ 48 mmol/mol)
Fasting plasma glucose (FPG) level ≥ 126 mg/dL (≥ 7.0 mmol/L)
Two-hour glucose tolerance test (OGTT) ≥ 200 mg/dL (≥ 11.1 mmol/L)
Random glucose ≥ 200 mg/dL (≥ 11.1 mmol/L) with symptoms of hyperglycemia
An oral glucose tolerance test is not required and should not be performed if diabetes can be diagnosed by other criteria. When needed, the test should be done using 1.75 g/kg (maximum 75 g) glucose dissolved in water; a positive result is a 2-hour plasma glucose level ≥ 200 mg/dL (11.1 mmol/L). The test may be helpful in children without symptoms or with mild or atypical symptoms and may be helpful in suspected cases of type 2 or monogenic diabetes.
Hyperglycemia suggested by an elevated HbA1C should be confirmed with a fasting or random plasma glucose. Although the HbA1C screening test is commonly used, and is recommended specifically for the diagnosis of type 2 diabetes in children (3), the results should be interpreted with caution because it can be affected by conditions causing altered red blood cell turnover (eg, hemoglobinopathies such as sickle cell disease) (4). For example, in children with cystic fibrosis, HbA1C can be falsely low because of chronic inflammation and abnormal red blood cell turnover (1), Similarly, increased red blood cell turnover due to hemolytic anemia can falsely lower the HbA1C, whereas iron deficiency anemia can falsely elevate it.
Diagnostic Criteria for Diabetes Mellitus and Prediabetes*
Test | Normal | Prediabetes (Impaired Glucose Regulation) | Diabetes |
|---|---|---|---|
FPG (mg/dL [mmol/L]) | < 100 (< 5.6) | 100–125 (5.6–6.9) | ≥ 126 (≥ 7.0) |
OGTT (mg/dL [mmol/L])† | < 140 (< 7.8) | 140–199 (7.8–11.0) | ≥ 200 (≥ 11.1) |
HbA1C (%) | < 5.6 (less than or equal to) | 5.7–6.4 | ≥ 6.5 |
Random glucose (mg/dL [mmol/L]) | < 200 (< 11.1) | — | > 200 (> 11.1) in a patient with symptoms |
* See also American Diabetes Association Professional Practice Committee. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(Supplement_1):S27-S49. doi:10.2337/dc25-S002 | |||
† An oral glucose tolerance test is not required and should not be performed if diabetes can be diagnosed by other criteria. When needed, the test should be done using 1.75 g/kg (maximum 75 g) glucose dissolved in water; a positive result is a 2-hour plasma glucose level ≥ 200 mg/dL (11.1 mmol/L). | |||
FPG = fasting plasma glucose; HbA1C = glycosylated hemoglobin; OGTT = oral glucose tolerance test, 2-hour glucose level. | |||
Initial evaluation
For patients who are suspected of having diabetes but who do not appear ill, initial testing to establish the diagnosis should include a basic metabolic panel, including electrolytes and glucose, and urinalysis to test for ketones.
For patients who are suspected of having diabetes and who are ill, testing also includes a venous or arterial blood gas analysis, liver tests, and calcium, magnesium, phosphorus, and hematocrit levels. Diabetic ketoacidosis can cause metabolic stress and hypoperfusion, which may impair liver function. Hematocrit reflects hemoconcentration due to dehydration, which is common in diabetic ketoacidosis; an elevated hematocrit suggests severe fluid loss and guides fluid resuscitation.
Evaluation for diabetes type
A comprehensive evaluation of clinical characteristics should be performed to help distinguish type 1 and type 2 diabetes (or other types) and interpreted in the context of additional laboratory studies. Type 1 diabetes is suggested by features such as younger age at diagnosis (< 35 years), lower body mass index (BMI) (< 25 kg/m²), unintentional weight loss, presence of ketoacidosis, and marked hyperglycemia at presentation. Type 2 diabetes is suggested by the presence of increased BMI, absence of weight loss, and milder hyperglycemia.
Additional tests that should be performed include:
C-peptide and insulin (if not yet treated with insulin) levels
Tests for the 5 autoantibodies against pancreatic islet cell proteins
C-peptide is a marker of endogenous insulin production, and low or absent C-peptide levels indicate severe insulin deficiency, which is characteristic of type 1 diabetes. Higher C-peptide levels are strongly suggestive of type 2 diabetes, where endogenous insulin production is preserved. In children with type 1 diabetes, levels of fasting insulin are inappropriately low relative to the plasma glucose concentration whereas high fasting insulin suggests type 2 diabetes. Autoantibody panels are expensive, so in low-resource countries, diagnosis often relies on clinical presentation and C-peptide levels rather than immunologic confirmation.
Autoantibodies include glutamic acid decarboxylase (GAD65A), insulin autoantibody (IAA), zinc transporter 8 (ZnT8A), islet cell antibody (ICA), and islet tyrosine phosphatase 2 (IA-2A) . At least 90% of patients with newly diagnosed type 1 diabetes have ≥ 1 of these autoantibodies, whereas the absence of antibodies strongly suggests type 2 diabetes (5, 6).
However, approximately 10 to 20% of children and young adults with the type 2 diabetes phenotype have autoantibodies and are reclassified as having type 1 diabetes; such patients are more likely to have a rapid progression to insulin therapy and are at greater risk of developing other autoimmune disorders (7, 8, 9) than patients with a type 2 phenotype and no antibodies.
Additional phenotypic differentiation between type 1 and type 2 diabetes in children plays a critical role because clinical presentation alone can be misleading. While autoantibody testing and C-peptide measurement are gold standards, phenotype helps guide initial management when these tests are unavailable or delayed (see table ). Key differentiating features include age, pubertal status, and severity at onset, body habitus, signs of insulin resistance, and associated conditions. This phenotypic assessment helps clinicians choose appropriate initial therapy (eg, insulin for suspected type 1 vs. metformin for type 2) and prioritize confirmatory testing.). Key differentiating features include age, pubertal status, and severity at onset, body habitus, signs of insulin resistance, and associated conditions. This phenotypic assessment helps clinicians choose appropriate initial therapy (eg, insulin for suspected type 1 vs. metformin for type 2) and prioritize confirmatory testing.
Monogenic diabetes should be considered in all infants 6 months of age diagnosed with diabetes, and in children and young adults (≤ 25 years) with a strong family history of diabetes and only mild, stable hyperglycemia (HbA1C < 7.5% [58 mmol/mol]) who do not have obesity, evidence of insulin resistance, or autoantibodies. Definitive diagnosis is by genetic testing.
Phenotypic Differentiation in Pediatric Diabetes
Feature | Type 1 Diabetes Mellitus | Type 2 Diabetes Mellitus | MODY/Monogenic Diabetes |
|---|---|---|---|
Body habitus | Usually lean | Overweight or obesity (central adiposity common) | Usually lean or normal weight |
Age at onset | Any age; peak 4–6 and 10–14 years | Typically post-puberty (≥ 10 years) | Neonatal (< 6 months) or adolescence/early adulthood |
Onset pattern | Abrupt, often with DKA | Gradual, often incidental hyperglycemia | Mild, stable hyperglycemia; often detected on screening |
Family history | Autoimmune diseases common | Strong family history of type 2 diabetes/metabolic syndrome | Strong autosomal dominant inheritance across generations |
Signs of insulin resistance | Rare | Common (acanthosis nigricans, hypertension, dyslipidemia) | Absent |
Associated conditions | Autoimmune (thyroid disease, celiac disease) | Obesity-related (MASLD, PCOS) | None; may have gene-specific features (eg, renal cysts, deafness) |
Ketosis/DKA at diagnosis | Frequent | Less common, but possible | Rare |
DKA = diabetic ketoacidosis; MODY = maturity-onset diabetes of the young; MASLD = metabolic dysfunction–associated steatotic liver disease; PCOS = polycystic ovary syndrome. | |||
Diagnosis references
1. American Diabetes Association Professional Practice Committee. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S27-S49. doi:10.2337/dc25-S002
2. Libman I, Haynes A, Lyons S, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes. 2022;23(8):1160-1174. doi: 10.1111/pedi.13454
3. Wallace AS, Wang D, Shin JI, Selvin E. Screening and Diagnosis of Prediabetes and Diabetes in US Children and Adolescents. Pediatrics. 2020;146(3):e20200265. doi: 10.1542/peds.2020-0265
4. Sacks DB, Arnold M, Bakris GL, et al. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Diabetes Care. 2023;46(10):e151-e199. doi:10.2337/dci23-0036
5. Cheng BW, Lo FS, Wang AM, et al. Autoantibodies against islet cell antigens in children with type 1 diabetes mellitus. Oncotarget. 2018;9(23):16275-16283. doi:10.18632/oncotarget.24527
6. Kawasaki E. Anti-Islet Autoantibodies in Type 1 Diabetes. Int J Mol Sci. 2023;24(12):10012. doi:10.3390/ijms241210012
7. Turner R, Stratton I, Horton V, et al. UKPDS 25: autoantibodies to islet-cell cytoplasm and glutamic acid decarboxylase for prediction of insulin requirement in type 2 diabetes. UK Prospective Diabetes Study Group. Lancet. 1997;350(9087):1288-1293. doi: 10.1016/s0140-6736(97)03062-6
8. Klingensmith GJ, Pyle L, Arslanian S, et al. The presence of GAD and IA-2 antibodies in youth with a type 2 diabetes phenotype: results from the TODAY study. Diabetes Care. 2010;33(9):1970-1975. doi: 10.2337/dc10-0373
9. Shah AS, Barrientos-Pérez M, Chang N, et al. ISPAD Clinical Practice Consensus Guidelines 2024: Type 2 Diabetes in Children and Adolescents. Horm Res Paediatr. 2024;97(6):555-583. doi:10.1159/000543033
Treatment of Diabetes in Children and Adolescents
Diabetes education
Healthy food choices and exercise
For type 1 diabetes, insulin
For type 2 diabetes, metformin and sometimes insulin , glucagon-like peptide 1 (GLP-1) receptor agonists, or sodium-glucose cotransporter-2 (SGLT2) inhibitors
Diabetes education
Intensive education and treatment in childhood and adolescence may help achieve treatment goals, which are to normalize blood glucose levels while minimizing the number of hypoglycemic episodes and to prevent or delay the onset and progression of complications. The American Diabetes Association recommends formal, multidisciplinary Diabetes Self management Education and Support for all youth with both type 1 and type 2 diabetes (1).
Nutrition and exercise
Lifestyle modifications that benefit all patients include:
Eating regularly and in consistent amounts
Limiting intake of refined carbohydrates and saturated fats
Increasing physical activity
In general, the term diet should be avoided in favor of meal plan or healthy food choices. The main focus is on encouraging children to eat heart-healthy meals that are low in cholesterol and saturated fats and that are suitable for all young people and their families. The goal is to improve diabetes outcomes and reduce cardiovascular risk. Nutrition therapy, including the services of a dietician when possible, should be offered to all patients, and clinicians should work with children with diabetes and their caregivers to create an individualized meal plan (1, 2). To optimize glycemic control, patients using insulin should be educated on how to adjust prandial ). To optimize glycemic control, patients using insulin should be educated on how to adjust prandialinsulin doses appropriately Setting up routines at mealtimes is also important to achieve glycemic targets.
Pharmacotherapy
The mainstay of pharmacotherapy for type 1 diabetes is insulin. For further discussion, see The mainstay of pharmacotherapy for type 1 diabetes is insulin. For further discussion, seeTreatment of Type 1 Diabetes in Children and Adolescents.
Both oral and injectable antihyperglycemic medications (such as metformin and GLP-1 receptor agonists), as well as insulin, are used for glycemic control in children with type 2 diabetes. Those with hypertension, chronic kidney disease, or other comorbidities that increase cardiovascular risk may also be treated with other medications such as angiotensin-converting enzyme inhibitors or Both oral and injectable antihyperglycemic medications (such as metformin and GLP-1 receptor agonists), as well as insulin, are used for glycemic control in children with type 2 diabetes. Those with hypertension, chronic kidney disease, or other comorbidities that increase cardiovascular risk may also be treated with other medications such as angiotensin-converting enzyme inhibitors orangiotensin II receptor blockers. For further discussion, see Treatment of Type 2 Diabetes in Children and Adolescents.
Methods for monitoring glycemic control
Routine monitoring involves 1 or more of the following:
Multiple daily glucose checks by fingerstick
Continuous glucose monitoring
HbA1C measurements every 3 months
Self-monitoring of blood glucose
Self-monitoring of blood glucose involves intermittent fingersticks to test capillary blood glucose using a glucose monitor (glucometer).
Self-monitoring is the traditional approach. Glucose levels are checked before all meals, before a bedtime snack, and if children have symptoms of hypoglycemia (3). Levels also should be checked during the night (around 2 to 3 AM) if nocturnal hypoglycemia is a concern (eg, because of hypoglycemia or vigorous exercise during the day, or when an insulin dose is increased). It may be necessary to take 6 to 10 readings a day when optimizing glycemic control.
Temporary adjustments are made if changes in glucose regulation are anticipated because of exercise or illness. Because exercise can lower glucose levels for up to 24 hours after activity, levels should be checked more frequently on days when children exercise or are more active. To prevent hypoglycemia, children may increase carbohydrate intake or lower insulin dosing when they anticipate increased activity. Sick-day management (measuring ketones and giving additional fluid and insulin if needed) should be used with hyperglycemia or illness.
Parents should use a journal, app, spreadsheet, smart meter, or cloud-based program to keep detailed daily records of all factors that can affect glycemic control, including blood glucose levels, timing and amount of insulin doses, carbohydrate intake, physical activity, and any other relevant factors (eg, illness, late snack, missed insulin dose). The shift to having children and adolescents monitor their own glucose levels, initially under supervision and later independently, should be guided by the child's developmental maturity and skill level.
Continuous glucose monitoring systems
Continuous glucose monitoring (CGM) systems are also a common method of monitoring blood glucose levels and replace routine self-monitoring of blood glucose by fingerstick for many children (3).
CGM systems are a more sophisticated and effective approach to glucose monitoring. They use a subcutaneous sensor to measure interstitial fluid glucose levels every 1 to 5 minutes and then translate the measurements into blood glucose values, thus more closely detecting glucose fluctuations that can then be acted on in real time. Results are transmitted wirelessly to a monitoring and display device that may be built into an insulin pump or may be a stand-alone device (ie, receiver, phone). By identifying times of consistent hyperglycemia and times of increased risk of hypoglycemia, CGM systems can help patients with type 1 diabetes more safely reach glycemic goals.
This photo shows a child with diabetes with a continuous glucose monitor and a sensor on the upper arm.
Dragoljub/stock.adobe.com
Given the significant burdens of monitoring requirements, CGM should be offered if available and if the patient and/or family can use the device safely. Most CGM devices now give real-time feedback about current glucose readings and trends with alarms for high and low thresholds and can replace self-monitoring of blood glucose. Compared to intermittent fingerstick monitoring, CGM systems can help lower HbA1C levels, increase the percentage of time-in-range, and lower the risk of hypoglycemia (3).
Children using a CGM device need to be able to measure blood glucose by fingerstick to calibrate their monitor and/or to verify readings if they are discordant from symptoms, but, after a brief warm-up period (30 minutes to 2 hours), many systems do not require regular calibration with fingerstick.
Two types of CGM systems are currently available for daily home use: real-time CGM and intermittently scanned CGM.
Real-time CGM (in the United States approved for use in children ≥ 2 years of age) automatically transmits a continuous stream of glucose data to the user in real time, provides alerts and active alarms, and also transmits glucose data to a receiver, smartwatch, or smartphone. Real-time CGM should be used as close to daily as possible for maximal benefit.
Intermittently scanned CGM (in the United States approved for use in children ≥ 4 years of age) provides the same type of glucose data as real-time CGM but requires the user to purposely scan the sensor with a reader or enabled smartphone to obtain information. Similar to real-time CGM, glucose data can be transferred remotely for review by parents or health care professionals. Many intermittently scanned CGM systems have optional alerts and alarms. Intermittently scanned CGM should be used frequently, a minimum of once every 8 hours. Children who use a CGM device need to be able to measure blood glucose with a fingerstick to calibrate their monitor and to verify glucose readings if they do not match their symptoms.
Although CGM devices can be used with any regimen, they are typically worn by patients who use insulin pumps. When used in conjunction with an insulin pump, the combination is known as sensor-augmented pump therapy.
Other CGM systems are integrated with a pump and can also suspend the basal rate for up to 2 hours when glucose levels drop below a set threshold (low glucose suspend system) or when they are predicted to drop below a set threshold (predictive low glucose suspend system). This integration can reduce the number of hypoglycemic events, even when compared to sensor-augmented pump therapy.
Closed-loop insulin pumps can be used in children ≥ 2 years of age. These hybrid closed-loop systems automate blood glucose management through sophisticated computer algorithms that are on a smartphone or similar device and link a CGM sensor to an insulin pump to determine blood glucose levels and control insulin delivery. Delivery is controlled by suspending, increasing, or decreasing basal insulin in response to CGM values. Some hybrid closed-loop systems allow for greater automation but still require input for mealtime boluses by the user. These systems help more tightly control insulin dosing, limit hyperglycemic and hypoglycemic episodes, and have optional settings for sleep and exercise. A fully automated closed-loop system, sometimes known as a bihormonal (insulin and glucagon) artificial pancreas, is not yet commercially available.
Monogenic diabetes management
Management of monogenic diabetes is individualized, based on subtype and the risk of complications or progression. For more detail, see Monogenic Forms of Diabetes.
Treatment references
1. American Diabetes Association Professional Practice Committee. 14. Children and Adolescents: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S283-S305. doi:10.2337/dc25-S014
2. Annan SF, Higgins LA, Jelleryd E, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Nutritional management in children and adolescents with diabetes. Pediatr Diabetes. 2022;23(8):1297-1321. doi: 10.1111/pedi.13429
3. Tauschmann M, Cardona-Hernandez R, DeSalvo DJ, et al. International Society for Pediatric and Adolescent Diabetes Clinical Practice Consensus Guidelines 2024 Diabetes Technologies: Glucose Monitoring. Horm Res Paediatr. 2024;97(6):615-635. doi:10.1159/000543156
Key Points
Most children have symptomatic hyperglycemia without acidosis, with several days to weeks of urinary frequency, polydipsia, and polyuria; children with type 1 diabetes and rarely type 2 diabetes may present with diabetic ketoacidosis.
Children with type 1 diabetes require insulin treatment; intensive glycemic control helps prevent long-term complications but increases risk of hypoglycemic episodes.
Children with type 2 diabetes may be treated with oral antihyperglycemic agents (metformin), insulin, and/or non-Children with type 2 diabetes may be treated with oral antihyperglycemic agents (metformin), insulin, and/or non-insulin injectable antihyperglycemic agents.
Advances in diabetes technology, such as continuous glucose monitoring systems, are aimed at improving glycemic control while reducing hypoglycemic episodes.
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