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Despite significant advances in therapies for pediatric type 1 diabetes, achievement of glycemic targets remains elusive, and management remains burdensome for patients and their families. This article identifies common challenges in diabetes management at the patient-provider and health care system levels and proposes practical approaches to overcoming therapeutic inertia to enhance health outcomes for youth with type 1 diabetes.
Effective management of type 1 diabetes requires frequent monitoring of blood glucose levels, calculation, and administration of insulin doses to match food intake while adjusting for a dynamic context of activity levels and physiologic requirements. For children with type 1 diabetes, these tasks must be coordinated between themselves and their caregivers. Over time, as children developmentally mature, it is reasonable for them to take on more responsibility for self-management in partnership with adult caregivers. Throughout all phases, children with diabetes benefit from the support of trained secondary caregivers such as school nurses, family members, and friends with appropriate diabetes education.
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