Autoimmune disorders

In autoimmune disease, the immune system mistakenly begins attacking healthy cells. This is different from other immune system malfunctions, such as acquired immunodeficiency disorders like AIDS, in which the immune system is weakened or ineffective, and allergic disorders, in which the immune system overreacts to things outside the body like pollen or nuts.

Generally autoimmune disorders fall into two groups – those affecting particular organs (such as Crohn’s disease which affects the gastrointestinal tract, or Type 1 diabetes which affects the pancreas), or systemic conditions, that cause problems throughout the body (such as juvenile arthritis, and lupus). Generally women are more likely to be diagnosed with an autoimmune condition, and having one increases the likelihood of having another.

Many autoimmune problems are diagnosed in adolescence and early adulthood. The peak age for diagnosis of Type 1 diabetes, for example, is between 9 and 14 (Diabetes UK 2021). We cannot provide a definitive overview of all the relevant conditions here, but present some illustrative data that stress the importance of considering how autoimmune disorders particularly affect young people.

Diabetes is a serious life-long health condition, where the amount of glucose in the blood is too high because the body cannot use it properly.  It may cause long-term complications and needs to be well managed.   Drawing on surveys from England, Wales and Scotland, the charity Diabetes UK has estimated that there are approximately 36,000 children and young people under the age of 19 who have diabetes. Of these, the great majority have Type 1 diabetes (90%).  The remainder have Type 2 and other rare forms (Diabetes UK, 2019). They also note that the first children with Type 2 diabetes were diagnosed in the UK in the year 2000.  Although still very uncommon, the number of cases of Type 2 diabetes in children and young people in the UK continues to rise, particularly among girls and South –Asian children (Candler et al, 2018).

Similar estimates of prevalence are provided in an annual national paediatric audit undertaken by the Royal College of Paediatrics and Child Health (RCPCH, 2021). The audit aims to monitor the incidence and prevalence of all types of diabetes among children and young people receiving care from a paediatric diabetic unit in England and Wales, of which there are 175. The 2018/19 audit included all the paediatric diabetic units in England and Wales and collected data on 30,155 children and young people up to the age of 24 years under the care of a paediatric consultant (all young people with diabetes should be under the care of a consultant but some may not be). In 2018/19, the prevalence of Type 1 diabetes in children and young people aged 0 to 15 years old in England and Wales was 196.4 per 100,000 of the general population; it was slightly higher among boys (198.1 per 100,000) compared to girls (194.6 per 100,000). Rates were very similar over the last three years.

Surveys also show that the peak age for diagnosis of Type 1 diabetes is between 9 and 14 years of age, and while most children and young people with diabetes are white, children and young people of non-white ethnicity have a disproportionately higher prevalence of diabetes (RCPCH, 2021; Diabetes UK, 2019). Type 1 diabetes is not related to obesity, but a rise in obesity among young people may result in more Type 2 diagnoses in the long-term. Being diagnosed with Type 2 diabetes when young appears to be associated with a more severe course and complications (Diabetes UK 2018).

Management of diabetes in young people can present challenges. All those over 12 years should have certain checks that are required to screen for various complications arising from the disease. Since 2004/05, there has been consistent improvement in the percentages of children and young people recorded as receiving essential health checks (RCPCH, 2021). In the 2018/19 audit, over 80% of young people aged 12 and above had the required foot and eye checks, a distinct improvement on previous years. Diabetic control was worse for young people if they lived in a deprived area (RCPCH, 2021).

Diabetic control also varies by age. It is usually measured by a blood test showing the average blood glucose (sugar) levels for the last two or three months (HbA1c). A low HbA1c measure is better than a high one. Chart 4.3 shows that diabetic control as measured by the National Diabetes Audit in 2018/19 was better at young ages than for older teenagers.

Looking at the rate of hospital admissions for diabetes per 100,000 population for 10-24 year olds in England from 2007/08 to 2018/19, Chart 4.4 suggests that emergency admissions for Type 1 diabetes have been fairly stable for those aged 10-19. However there has been an increase in emergency admissions for diabetes in young adults aged 20-24. This is the time when young people with diabetes transition from paediatric to adult services. 

The National Diabetes Audit also reported that over a third (39.1%) of children and young people with Type 1 diabetes were assessed as requiring additional psychological or CAMHS support. There was a higher proportion of adolescent girls with diabetes recorded as requiring additional psychological support compared to adolescent boys (RCPCH 2021).

Arthritis, an inflammatory joint disease, is rare in young people. It covers several related conditions occurring before the age of 16, including juvenile rheumatoid arthritis and juvenile idiopathic arthritis (definitions of which overlap). Despite being rare, it is estimated that juvenile idiopathic arthritis affects approximately 1 in 1000 children in the UK (CCAA 2021). 

All data correct as of 1st November 2021