Since endocrine diseases have a prolonged course and frequent complications, the quality of life deteriorates significantly and the life expectancy of sick children and adolescents is reduced. The incidence of diabetes along with significant prevalence of obesity in Russia is slowly but steadily increasing. Congenital hypothyroidism in regions with severe iodine deficiency is observed in more than 1% of children. Due to its belated and the late start of substitution therapy the child suffers an irrevocable decrease in intelligence and social adaptation. The rate of reproductive system diseases has increased over the past 5 years from 7-8 to 15-18%. Early sexual dysfunction reduces the fertility potential of future generations and threatens the country's demographic security.
DIABETES MELLITUS
Diabetes mellitus (DM), as defined by the WHO, is a state of chronic hyperglycemia that develops as a result of the effect of genetic or exogenous factors, often complementing each other. Hyperglycemia can be due to either a lack of insulin or an excess of factors that counteract its activity.
Table 10.1. Classification of glycemic disorders (WHO, 1999)
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Diabetes mellitus type 1 (autoimmune, idio-pathic) | β-cell destruction usually leading to absolute insulin deficiency |
| Primary insulin resistance with relative insulin deficiency or a predominant secretory defect with or without insulin resistance |
Other specific types of diabetes mellitus | Genetic defects and genetic syndromes combined with diabetes. Diseases of the exocrine part of the pancreas (pancreatitis, tumors of the pancreas, etc.). Endocrinopathies (Cushing's syndrome, acromegaly, pheochromocy-toma, etc.). Drug-induced diabetes mellitus (glucocorticoids, thyroid hormones, α- and β-adrenergic agonists, nicotinic acid, thiazide diuretics, simv-astatin, etc.). Damage to β-cells by cytomegalovirus, rubella virus |
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Type 1 diabetes most often presents in childhood and adolescence, and type 2 diabetes develops in adults, however, over the past decade, its greater incidence associated with obesity has been noted in children in industrialized countries.
Clinical classification of DM in children is presented in table 10.2.
Table 10.2. Clinical classification of diabetes
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| Compensation, subcompensation, decompensation |
Acute complications of diabetes | Ketoacidosis and hyperglycemic coma; hyperglycemic hyperosmolar coma, lactic acidotic coma |
Late complications of diabetes | Microangiopathies (retinopathy, nephropathy); macroangiopathies (diabetic foot syndrome, stroke, myocardial infarction, etc.); neuropathy (polyneuropathy, autonomic neuropathy, encephalopathy) |
Complications of insulin therapy | Hypoglycemic states and hypoglycemic coma; allergic reactions to insulin |
Involvement of other organs and systems | Enteropathy, cataract, osteoarthropathy, dermopathy; Mauriac syndrome |
• The spread of diabetes has become so menacing that this disease can be called non-infectious epidemic of the XXI century.
• The average annual rate of increase of incidence in children in
• Russia in the past 5 years is about 3%, in addition, diabetes shows its onset in younger patients.