The first ever guidelines for managing type 2 diabetes in children aged from 10 to 18 years have been issued by the American Academy of Pediatrics (AAP).

The AAP explained that over the last thirty years, childhood obesity rates have risen “dramatically” throughout the country, bringing with them several health problems, including type 2 diabetes. However, a study carried out by researchers from the Center for Disease Control and Prevention found that obesity rates among children in the USA did not change much during the first ten years of this millennium

Type 2 diabetes used to affect only adults – its incidence in children was extremely low. This is no longer the case. The rapid emergence of type 2 diabetes among children poses challenges to many doctors, who find themselves having to treat children with an “adult disease”.

Most family doctors are used to dealing with type 1 diabetes in children, not type 2.

The AAP explained that it is now time to help doctors who have to care for pediatric patients who have developed type 2 diabetes. It has issued a Clinical Practice Guideline that provides evidence-based recommendations for their 10 to 18 year old patients who have type 2 diabetes.

In an online communiqué, the AAP wrote that “The guidelines are the first of their kind for this age group.”

The guidelines were written in consultation with the Academy of Nutrition and Dietetics, the American Diabetes Association, the American Academy of Family Physicians, and the Pediatric Endocrine Society.

The guidelines, along with an accompanying Technical Report, are published in the Academy’s journal Pediatrics (February 2013 issue); they were released online today.

Children and teenagers who are ketotic or in ketoacidosis, very hyperglycemic, or those whose diabetes cannot be clearly defined as a type 1 or 2 should start treatment with insulin, according to the guidelines.

In all other pediatric cases, the recommended first-line therapy is metformin, as well as diet and exercise (modification program including physical activity and nutrition).

The guidelines include recommendations for:

  • diet
  • implementing insulin regimes
  • monitoring children’s glycemic control
  • physical activity

The authors wrote in Pediatrics that:

“The clinical practice guideline underwent peer review before it was approved by the AAP. This clinical practice guideline is not intended to replace clinical judgment or establish a protocol for the care of all children with T2DM, and its recommendations may not provide the only appropriate approach to the management of children with T2DM. Providers should consult experts trained in the care of children and adolescents with T2DM when treatment goals are not met or when therapy with insulin is initiated.”

Some primary care physicians may feel ill-equipped about successfully treating type 2 diabetes in children, because of their age, coexisting conditions, and some other concerns. If a GP (general practitioner, primary care doctor) feels he/she is not properly trained or is unsure about treatment, the child should be referred to a pediatric medical subspecialist, the AAP recommends.

If the pediatric medical subspecialist diagnoses type 2 diabetes, the primary care doctor needs to develop a co-management strategy with the specialist to make sure that the patient “continues to receive appropriate care consistent with a medical home model in which the pediatrician partners with parents to ensure that all health needs are met.”

Detecting type 2 diabetes in kids is difficult because:

  • It can go undiagnosed for a long time
  • Kids may have either no symptoms or very mild ones
  • Blood tests are needed for diagnosis
  • Criteria for differentiating between types 1 and 2 diabetes in children are confusing. Signs and symptoms of one type can appear in the other type in this age group. For example, children with type 1 may be obese, or kids with type 2 may develop ketoacidosis.

It is even harder to determine how many children nationally have types 1 and 2 diabetes.

Researchers have been reporting on a rapid rise in both type 1 and type 2 diabetes rates among children in Western Europe and the USA. A 2009 study reported in The Lancet predicted that the number of type 1 diabetes cases in Western Europe among children under 5 years of age is set to double, and to rise by 70% among children under 15 years within the next twenty years.

Written by Christian Nordqvist