Clinical guidelines for type 1 diabetes in children have been updated

According to the definition given in the document, diabetes mellitus is a large group of complex metabolic diseases characterized by chronic hyperglycemia caused by impaired secretion or action of insulin. Type I diabetes mellitus is a pathology that occurs as a result of autoimmune destruction of insulin-producing β-cells of the pancreas. Subsequently, absolute insulin deficiency develops.

According to the International Diabetes Federation (IDF), the total number of children and adolescents suffering from the pathology exceeded 1.2 million people in 2021, with more than half of them (54%) being children under 15 years of age. In addition, over 108 thousand children under 14 years of age and more than 41 thousand adolescents aged 15 to 19 years fall ill with type 1 diabetes every year. The previous version of the clinical recommendations stated that about 96 thousand children under 15 years of age fall ill worldwide every year. In addition, both the previous and current versions of the document named Finland as one of the countries with the highest incidence of the pathology among children. According to new data, 50 people per 100 thousand of the child population suffer from the disease in this country. The previous version of the recommendations indicated 20 people per 100 thousand.

In Russia, the number of minors diagnosed with the disease at the end of 2023 was 61.3 thousand people, or 208 per 100 thousand of the child population. The incidence rate in 2022 was 27 cases per 100 thousand children and 36 per the same number of adolescents. For comparison: according to data from the previous version of clinical recommendations, in 2016 the incidence rate was 14.2 and 10 cases per 100 thousand children and adolescents, respectively.

The clinical guidelines also state that approximately 80% of children with type 1 diabetes experience partial remission or a "honeymoon" after starting insulin therapy. This condition can last from several weeks to a year, and in rare cases, more than a year. Remission is temporary and does not mean a cure for the disease, the document notes. Complete remission is a condition in which the patient's glycemic indicators are not disturbed when insulin administration is stopped.

The diagnosis of type I diabetes mellitus is established on the basis of symptoms and test data such as polyuria, polydipsia, weight loss, weakness, fatigue, recurring skin infections, fasting venous plasma glucose levels greater than or equal to 7 mmol per liter, and others.

Treatment for type 1 diabetes includes insulin therapy, self-monitoring education, nutrition, exercise, and psychological support. In addition, the updated document recommends using a continuous blood glucose monitoring system throughout the day.

The KR also sets out an algorithm of actions when transferring a patient from one insulin preparation to another. In the case of different INNs, such a transition should be carried out only with the participation of a doctor and the presence of medical indications. The patient is required to conduct more frequent self-monitoring of glucose levels, and a dose adjustment may also be necessary. If the INNs of the drugs are the same, then transferring a patient from one drug to another usually does not require more frequent monitoring of glucose levels or a change in dosage. However, certain rules provided for specific drugs should be followed if insulin preparations with the same INNs have different pharmacokinetics and pharmacodynamics. If adverse reactions develop, they should be reported to Roszdravnadzor.

The KR also included a recommendation to consider the possibility of sanatorium-resort treatment for patients with type I diabetes to improve their overall health. The previous version of the document stated that specific rehabilitation measures for this type of disease were not provided.

In November 2024, the Russian Government distributed funding for the federal project "Fight against Diabetes" among the regions for various purposes. Of the total amount of 6.6 billion rubles, the largest tranche of 4.26 billion rubles will be allocated to the creation and equipping of endocrinology centers, as well as health schools for patients with diabetes. 53 regions will receive the funds. The functioning of such units is regulated, among other things, by the Procedure for the provision of medical care in the profile of "children's endocrinology", updated in the same year.

In April 2025, the Russian Ministry of Health approved a list of medical products and other equipment for equipping regional and inter-district centers providing medical care to patients with carbohydrate metabolism disorders and diabetes.