Endocrine Abstracts

Diabetes which is not type 1 or type 2 makes up a very small proportion of all diabetes cases in children and adolescents. The value of recognising these is that treatment and outcome can be very different from that seen in type 1 or 2.

Other forms of diabetes can be divided into several groups:

1. Genetic diabetes including MODY and neonatal diabetes. MODY can be confused with type 1 diabetes in children. Making the diagnosis can be important in determining treatment (some types are better managed on oral medication) and can have genetic consequences for the family.

2. Diabetes associated with syndromes such as Prader Willi, Alstroms, and Laurence Moon Biedl. The diagnosis is usually clear, with a diabetes pattern similar to type 2 diabetes. Management can be complicated by other co-morbidities and learning difficulties.

3. Mutations of the insulin receptor, such as leprechaunism or Rabson-Mendenhall syndrome.

4. Diabetes related to pancreatic failure such as in Cystic Fibrosis and haemochromatosis.

For individuals with other complex medical problems, management of diabetes can be a significant burden. A balance needs to be struck between providing a regimen and treatment goals which are achievable for the patient and giving best diabetes control to maintain health. A good example of this is cystic fibrosis related diabetes where previously diabetes treatment was though to be too burdensome for individuals with such significant other health problems. However, recognition of the impact of diabetes and glucose control on lung function and survival in CF has changed this completely, and individuals with CF are screened for diabetes and insulin treatment started at an early stage.