Insights from ISPAD 2024: Transformative and Urgent Challenges in Youth Diabetes and Obesity Care

As we observe Diabetes Awareness Month this November, I recently returned from the International Society for Pediatric and Adolescent Diabetes (ISPAD 2024), where discussions underscored how critical and complex managing youth diabetes and obesity has become. Some noteworthy themes were:

🔬 Neuroinflammation and Obesity: Research highlights that youth with overweight/obesity experience elevated white matter neuroinflammation, regardless of dysglycemia status. This could influence early brain health, even without progressing to diabetes.

🧬 Gut Microbiome Shifts in Youth-Onset Type 2 Diabetes: A study on metformin and liraglutide in youth shows positive shifts in bile acid and short-chain fatty acid-producing gut microbiota. While the clinical relevance of these microbiome changes is not yet clear, this could guide future treatment paths.

💔 The Global Crisis of Diabetes: 537 million people worldwide live with diabetes, including 9 million with type 1 diabetes (T1D). T1D alone results in an average of 32 years of healthy life lost per person. In the U.S., people with T1D face a daily struggle—spending on average 7 hours in hyperglycemia and over 90 minutes in hypoglycemia.

💡 Rethinking T1D Management: Most people with T1D do not consistently achieve target blood glucose levels. A multidrug approach (insulin + SGLT inhibitors, etc.) may offer a more robust metabolic control to reduce risks, but more studies are needed to build clinical guidance and incentivize investment in these therapies.

📈 Equity in Access to Technology: Diabetes technology access is far from equitable. Many children and families face barriers like the lack of continuous glucose monitors (CGMs) and resources in multiple languages. As one parent expressed, "The pump is one thing...but you should walk out of the hospital with a sensor." The necessity of CGMs for safe, daily management is clear, yet disparities persist.

💤 Psychosocial Impacts on Families: The mental load on caregivers of children with T1D is profound. Psychosocial support, automated insulin delivery, and access to psychologists can dramatically improve quality of life for both the young patient and their families, leading to benefits that begin early and are sustained over time.

⚖️ Weight Loss and Obesity: Youth obesity remains a predictor of future cardiovascular disease. Effective weight management, including surgical options, shows promising improvements in metabolism and appetite control versus restrictive dieting, addressing the broader spectrum of comorbidities linked to obesity.

💬 Empowering Adolescents: Addressing body image, disordered eating, and the psychosocial aspects of T1D is essential. Diabetes education and support for youth must extend beyond clinical targets to encourage healthy body relationships and long-term mental well-being.

Main Takeaways from ISPAD

Diabetes as a Lifelong Health Crisis

With diabetes affecting 537 million globally, the statistics shared were a sobering reminder of the condition’s reach. For individuals with type 1 diabetes (T1D), the daily experience is relentless. The average person with T1D spends seven hours a day in hyperglycemia, plus over an hour and a half hypoglycemic. This “glycemic roller coaster” has serious implications for daily quality of life and cognitive functioning, underscoring how crucial it is to innovate and improve diabetes management. A stronger focus on simplifying glycemic control is essential to empower patients and reduce long-term risks.

Addressing Inequity in Diabetes Technology Access

The discussions around CGM access highlighted the structural barriers that many families face in managing diabetes effectively. While CGMs provide invaluable data for managing T1D, many families lack access to this technology due to socioeconomic factors or language barriers. The insights shared on racial and ethnic disparities in diabetes management hit home. Technology can only be transformative if it’s accessible and adaptable to diverse needs, including in the languages patients and families understand.

Recognizing the Toll on Families

The psychosocial burden on families dealing with T1D is substantial. Studies highlighted how support systems, such as psychologists and advanced technologies like automated insulin delivery, are essential to alleviate this burden. The research on how these interventions improve the mental well-being of both patients and parents reaffirms the value of a holistic approach. It was eye-opening to see how, with the right support, families experience less stress, better sleep, and more confidence in managing the disease.

A New Look at Weight Management and Obesity Treatment

Discussions on the physiological effects of restrictive dieting versus weight loss surgery illuminated why sustainable weight loss is such a challenge for young people. Restrictive diets often lead to physiological compensation—slower metabolism and increased appetite—making long-term weight management difficult. In contrast, surgical interventions seem to have opposite effects, improving factors like appetite control and energy expenditure. It was clear that for youth dealing with obesity and its comorbidities, a tailored, non-restrictive approach may be essential to achieve lasting health benefits.

Empowering Youth with a Holistic Approach

Finally, the emphasis on supporting youth with T1D around body image and disordered eating was a welcome reminder that effective care goes beyond physical health metrics. Adolescents with diabetes face unique challenges around body image, so education that supports both their mental and physical well-being is critical.

The Silent Impacts of Obesity on Brain Health

The research showing elevated neuroinflammation in the white matter of youth with overweight or obesity was compelling, particularly as it occurs independently of blood sugar status (dysglycemia). This underscores the silent but serious neurological impact of excess weight in young people—a reminder of how comprehensive our approach to obesity care must be. It isn’t just about metabolic risk; we may need to consider cognitive and developmental factors early on.

Microbiome Research Raises New Questions

The shifts in gut microbiota observed in youth with type 2 diabetes taking metformin or metformin + liraglutide—especially the increase in bile acid concentrations—point to emerging opportunities. Though these changes aren’t directly tied to glycemic outcomes, they hint at complex metabolic pathways that could open doors to more personalized therapies. It’s exciting but also a reminder that our understanding of the microbiome's role in metabolic health is still evolving.

ISPAD 2024 was a powerful reminder of the importance of viewing diabetes and obesity through a multidimensional lens that integrates clinical, psychological, and social factors. As we raise awareness this November, it’s clear that both the clinical and psychosocial dimensions of diabetes and obesity care must advance in tandem. To truly make a difference, we need equitable access to technologies, a strong focus on prevention, and a compassionate approach to family support. This conference reinforced my belief in the need for innovation that is as much about inclusivity and mental well-being as it is about clinical efficacy.