Diabetes mellitus is a condition that causes a person’s blood sugar (glucose) to be high. Two main types exist:

Type 1 (T1DM): failure of the body to produce insulin, a hormone that regulates blood sugars. This type is typically diagnosed in children and young adults but occurs much less frequently in infancy or the first few years of life.
Type 2 (T2DM): failure of the body to make enough insulin or failure of the cells in the body to respond adequately to the insulin produced. This is more common in children and adults who have a higher Body Mass Index (BMI) and so much of the discussion here will be limited to T1DM.

Worldwide incidence of T1DM varies greatly by region of the world. Quality studies in Africa are limited, but overall suggest a low rate of T1DM. The highest rates are in Europe and North America and peak at 42 per 100,000 children in Finland. China has one of the lowest incidence rates worldwide.1,2

While it would be theoretically possible to occur, it is very rare to see an adoption referral for a child with T1DM. One of the reasons for this is that in this condition, the first presentation of very high blood sugar is very dangerous but can often look like a bad cold or flu and is not recognized until the child is extremely ill. In institutional care, it is something that may not be picked up in time to help the child. In other low resource countries, even if it is recognized, there may not be the resources to do adequate blood sugar testing and insulin injections that are needed to control the child’s blood sugar levels. Lastly, there are very few cases of T1DM diagnosed in early childhood when most children are being adopted.

If adopted with diabetes, children typically require daily monitoring of blood sugars, insulin administration (either by injection or by insulin pump), and management of their diet and physical activity. Children are usually seen by their primary pediatrician as well as a pediatric endocrinologist. While medical complications can occur, life expectancy has increased dramatically with current interventions.3

In summary, while diabetes is a condition that is rarely (if ever) seen in international adoptions, adopting a child with diabetes is a daily commitment to monitoring and medications but with this, a child can lead a full and healthy life.

Summary
* Almost never seen in the preadoption information
* Will require daily monitoring and medications
* Most lead fully and healthy lives with medical interventions

References

1. Soltesz G, Patterson C, Dahlquist G. Worldwide childhood type 1 diabetes incidence–what can we learn from epidemiology? Pediatric Diabetes. 2007;8(s6):6-14.

2. Karvonen M, Viik-Kajander M, Moltchanova E, Libman I, LaPorte R, Tuomilehto J. Incidence of childhood type 1 diabetes worldwide. Diabetes Mondiale (DiaMond) Project Group. Diabetes Care. 2000;23(10):1516-1526. 

3. Miller RG, Secrest AM, Sharma RK, Songer TJ, Orchard TJ. Improvements in the life expectancy of type 1 diabetes The Pittsburgh Epidemiology of Diabetes Complications Study cohort. Diabetes. 2012.

This article was generously shared by Dr. Judith Eckerle of the University of Minnesota, Adoption Medicine Clinic. Child referrals are becoming increasingly complex, and adoption medicine professionals are identifying many more children with special needs from all countries that participate in intercountry adoption, as well as from the United States. To help families prepare for these changes, Dr. Eckerle and other medical specialists are writing a book: Health Topics For Preadoptive Families.