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Re: [IPk] diabetes and siblings - any risk?

I have just noticed this thread and I was a little surprised to see someone
mention that they might seek sterilisation after having a child diagnosed with
diabetes. I can throw a little light on this subject, because when teaching
some GP's in Bahrain recently, they looked up the risk for children when one
or both parents have diabetes.

The first thing to say is, that as long-term conditions go, diabetes is not
that bad. I'm comparing here to cancers, cystic fibrosis, even less inherited
disorders of childhood like arthritis or inflammatory bowel disease. Sure, at
the time a child is diagnosed, the World falls in, but 2 or 5 years later, it
should not seem anything like as bad. Notions of choosing between children are
emotive and are a reality in Africa, not the UK.

Second, any child diagnosed today does not have to face a lifetime of
diabetes. We will see commercially available closed loop solutions within 5-8
years, sooner I hope. Did I mention that people are using long-term implanted
glucose sensors now for up to 30 months? One very good reason to be at the
cutting edge by using pump therapy.

Third, the incidence (ie how many new cases develop per 100,000 of population)
of diabetes in childhood remains LOW, around 5, that is one child in 20,000
population per year. Hence, the additive effect of having a genetic
predisposition, which might double this risk, is not substantial in terms of
individual risk. This is very important when a child develops diabetes and the
parents wonder 'what is the risk to a future child?'. Now clearly Kayleigh has
a very different family risk profile, but this is most unusual, and anyone can
understand why she made the decision she did. For most parents, the risk to
future children could be described as not an issue, since we are talking about
a condition we can live with and a low risk anyway (bearing in mind that 2% of
all pregnancies are affected by an important abnormality of one sort or

What if a parent has diabetes? The information my students came up with is
interesting. Mums with diabetes have a bigger effect than dads, and the
mother's age has an effect, the motto being: Have your kids earlier in life.
The risk for one parent is around 1-2%, for both parents having diabetes 3-5%.
Genetics matter, but they are not the only thing. This does not mean the child
will develop diabetes in childhood, and don't forget the lifetime population
risk is of the order of 10%. Risks rise as mum enters her 30's, but only
slightly, so this information is useful for those lucky enough to really
'plan' their families. It's a long time since I met anyone that organised!

One last point we should consider to complete the picture. Kids grow out of
their parents' influence in their early twenties in our societies, but remain
in a close link with their siblings long after that. If I had a child with
diabetes (and I do not), I might consider having more children intentionally
to provide on-going support through the treacherous twenties for my child with
diabetes. Personally, I would certainly not be put off having more children
because of that.

I am a GP with diabetes, and I do advise parents about these issues. For me,
parents are too concerned about physical perfection, and not concerned enough
about the welfare of developing children. Kids with physical problems from
hare lip to diabetes just get on with it and enjoy complete lives, but every
time I see parents breathe a sigh of relief that their baby is physically
perfect, I wonder whether the child will turn out to have autism, alcoholism
or to be a bank robber. Life puts these obstacles in our way, we are supposed
to deal with them, not waste our energies trying to avoid them all!

Tony O'Sullivan
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