The number of children who are annually diagnosed with type 1 diabetes has doubled over the last 30 years. This is one of the conclusions of the PhD thesis written by Angelien Spaans-Hummelink, who works as a paediatrician at the diabetes clinic at the Isala regional hospital (Zwolle). Spaans conducted her research in collaboration with the University Medical Center Groningen. ‘Clinical questions formed the basis of this research. We had the feeling that an increasing number of children were being diagnosed with the disease, particularly in winter, and we also wondered if adolescents can regulate their blood sugar levels themselves. In my thesis, I investigate and summarize these issues and others’. Spaans has defended her thesis at the University of Groningen on 15th of May.
Children with type 1 diabetes must measure their glucose levels by drawing blood from one of their fingers several times a day. Instead of injecting insulin, many children now use an insulin pump, for which they must regularly configure their blood sugar levels and the required amounts of insulin. They always have to pay attention to their diets how much sugar they eat . If this monitoring fails, they may develop hypo- or hyperglycaemia: an intense experience for both the children and those close to them. Although the technology is improving, making it “easier” to measure glucose levels and administer insulin, a drug that will prevent the need to inject insulin is not yet on the horizon.
More often in winter
In addition to an increase in the number of young patients, Spaans’ research also shows that the diagnosis is most often made in winter. Spaans used data about children aged 0 to 14 years from Vektis, a database used by health insurers to record information about diagnoses made and prescriptions issued. ‘The increase in the number of diagnoses and the fact that they are seasonal is not unique to the Netherlands’, she says, ‘We see this all over the world’. As yet, there is no sound explanation for this seasonal variation. ‘Although it is believed that it has something to do with viruses, this has not been proven conclusively’. It is remarkable, incidentally, that children aged 0 to 4 years more often receive the diagnosis in the spring.
Type 1 diabetes is an autoimmune disease in which a person’s immune system turns against one of their own organ systems, causing it to malfunction. ‘We already know that children with type 1 diabetes relatively often have a second autoimmune disease, such as hypo- or hyperthyroidism or coeliac disease (gluten intolerance)’. Spaans also found evidence for this: children with type 1 diabetes are 24 times more likely to also have a thyroid disorder. Because the treatment of coeliac disease does not include medication, Spaans could not find any relevant information about this disorder in the database.
Living with type 1 diabetes often becomes even more complicated during puberty. Adolescents do not always want to tell others that they have diabetes, and simply want to live ‘like anyone else’. They often feel that measuring their glucose is not really important, they also often forget it and they eat snacks with their friends. Meanwhile, they increasingly break away from their parents and do not want them interfering in their lives. ‘We often see that parents, too, feel that their children should be able to regulate their own blood sugar once they turn 16 or so, and adolescents also want this themselves’. Spaans investigated whether adolescents are indeed self-reliant enough to do so. ‘I monitored 90 adolescents to see whether they always measured their glucose levels and administered sufficient insulin before meals. It appears that they often fail to do so. However, every time they do, their glucose levels get better’. Spaans showed that adolescents who measure their blood glucose properly and administer the right amounts of insulin before every main meal are six times more likely to meet their target glucose levels than adolescents who do not do so.
‘It is remarkable that adolescents show increasingly less compliance the older they become. As a paediatrician, I am inclined to grant adolescents their independence and not always involve the parents. However, it appears that parental action is nonetheless necessary sometimes. More research needs to be done to find the right balance between letting go and continued supervision’.
Angelien Spaans-Hummelink (1967, Huizen) studied Medicine at the Vrije Universiteit Amsterdam and specialized as a paediatrician at the Leiden University Medical Center. She conducted her PhD research at the diabetes clinic of Isala Clinics (Zwolle), in collaboration with the UMCG. The title of her thesis is ‘Scope of epidemiology and daily practice in children with type 1 diabetes mellitus in the Netherlands’. After receiving her PhD degree, she will continue to work as a paediatrician at Isala Clinics, Zwolle.