Type 2 Diabetes in Kids, New Management Guideline

Type 2 diabetes in kids
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The rise in type 2 diabetes in kids is a major health concern, sending parents and healthcare professionals alike scrambling for answers. To help with this growing challenge, the American Academy of Pediatrics has just released the first-ever management guideline for type 2 diabetes in kids ages 10 to 18 years.

Type 2 diabetes in kids is on the rise

Type 2 diabetes used to be considered an adult’s disease, developing in men and women around age 40. In recent years, however, a growing number of children and adolescents have been developing type 2 diabetes, and one reason is the rising prevalence of overweight and obesity among these young people.

In fact, the authors of the new guideline note that currently in the United States, as many as one-third of new cases of diabetes diagnosed in people younger than 18 years is type 2 diabetes.

Children and adolescents are not little adults; they need to have medical care and drug dosing that takes into account their age, size, and stage of development. To address the needs of young people with type 2 diabetes, the American Academy of Pediatrics has issued a Clinical Practice Guideline, which it prepared in cooperation with the Academy of Nutrition and Dietetics, the American Diabetes Association, the American Academy of Family Physicians, and the Pediatric Endocrine Society.

The AAP emphasizes that the guideline “is not intended to replace clinical judgment or establish a protocol for the care of all children” who have type 2 diabetes, nor should the recommendations be considered to “provide the only appropriate approach to the management of children” with the disease.

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According to the Centers for Disease Control and Prevention (CDC), children and teens who are diagnosed with type 2 diabetes usually are between the ages of 10 and 19 years, are obese, have insulin resistance, and a strong family history of type 2 diabetes. Although young people of all ethnic groups are involved, Native Americans are the most affected, with high rates among Hispanics and Blacks as well.

It’s important to note that type 2 diabetes is not just a problem among American youth. The disease is a global concern, with rates exploding among Chinese kids, for example.

Guideline for type 2 diabetes in kids
If you are the parent of a child who has type 2 diabetes, the Clinical Practice Guideline offers a wealth of information on how doctors can help children who have developed type 2 diabetes. Here is a brief look at some of the recommendations.

  • General practitioners who do not feel they are adequately trained to manage type 2 diabetes in children and adolescents should refer their young patients to a pediatric medical subspecialist
  • Kids and adolescents who have very high blood sugar levels (hyperglycemia; 250 mg/dL or higher), who have a hemoglobin A1c (HbA1c) level of 9% or higher, who are ketotic or in ketoacidosis (accumulation of acid in the blood), or whose diabetes cannot be clearly identified as being type 1 diabetes or type 2 should be started on insulin
  • Young people who do not fall into the previous category can be started on the drug metformin and a diet and exercise program
  • Doctors should monitor HbA1c every three months
  • Physicians should encourage young people to engage in moderate to vigorous exercise daily for at least 60 minutes
  • Nutrition counseling should be part of the program, and doctors should use the Academy of Nutrition and Dietetics’ Pediatric Weight Management Evidence-Based Nutrition Practice Guidelines. These guidelines include daily calorie recommendations and evidence-based treatment options.
  • Limiting nonacademic screen time (TV, video, computer) to less than 2 hours per day

The rise in type 2 diabetes among children places these young people at great risk for a wide variety of serious health problems in their future. Heart disease, neuropathy (nerve pain), vision problems, amputations, gum disease, and other challenges could be hitting them at a time when they should be starting their careers and families.

All parents need to be aware of the possibility their children may be at risk for type 2 diabetes, especially if the youngsters are overweight or obese. Although the new management guideline for type 2 diabetes in kids is an important step, prevention is still the best and most healthful action.

SOURCES:
Centers for Disease Control and Prevention
Copeland KC et al. Management of newly diagnosed type 2 diabetes mellitus (T2DM) in children and adolescents. Pediatrics 2013 Jan 28. Published online. DOI: 10.1542/peds.2012-3494

Image: Morguefile

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