Experts release first-ever guidelines for treating diabetes in youth

Jan. 28, 2013, 2:25 p.m.

Insulin. Experts wrote in new guidelines that in children where it's unclear whether they have type 1 or type 2 diabetes, insulin is an appropriate treatment option. (Adrian Black/Flickr Creative Commons)

It used to be that children rarely, if ever, got type 2 diabetes. That was an adult condition.

But now, thanks in part to a spike in child obesity rates, young people have to contend with type 2 diabetes, sometimes well before they're old enough to drink.

That's become a challenge for doctors, who have become used to treating the condition in adults. That's why the American Academy of Pediatrics has released the first official guidelines on how to treat the disease in children.

"Over the past three decades, the prevalence of childhood obesity has increased dramatically in North America, ushering in a variety of health problems," wrote the authors. Type 2 diabetes is among them, and doctors are "generally ill-equipped" to treat it in patients who are between 10 and 18 years old.

The guidelines are as follows:

1. If it's unclear whether children have type 1 or type 2 diabetes, health providers should start them on insulin treatment. That same goes for patients who have markedly high blood sugar levels, are in ketoacidosis or have elevated ketone levels.

2. In all other cases that don't meet any of the criteria listed above, health providers should start patients on a regimen ofmetformin and lifestyle changes: namely, diet and physical activity.

3. Health providers should monitor blood sugar levels every three months using a lab test known as an HbA1c; if those tests don't yield promising results then providers should "intensify treatment."

4. Patients who a) are taking insulin or other medications and have a risk of high blood sugar, b) are in the middle of changing their diabetes treatment regimens, c) haven't met their treatment goals or d) have several illnesses or conditions should monitor their own blood sugar by way of a finger-stick test three or more times a day.

5. Health providers should have their patients follow diet guidelines from the Academy of Nutrition and Dietetics "at the time of diagnosis and as part of ongoing management."

6. Patients with type 2 diabetes should engage in "moderate-to-vigorous" exercise for at least an hour every day, and should "limit nonacademic screen time to less than 2 hours per day."

The authors concluded by noting that although type 2 diabetes in children is probably more aggressive – "as reflected by the age of onset" – it remains to be seen whether the associated health effects and complications are equally aggressive. They also highlighted just how many unknowns they were working with.

"Evidence for medical interventions in general is scant and is especially lacking for interventions directed toward children who have developed diseases not previously seen commonly in youth," wrote the authors.

The guidelines appeared in the journal Pediatrics.

Photo by Adrian Black via Flickr Creative Commons.

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