Over the past three decades, the prevalence of childhood obesity
has increased dramatically in North America, ushering a host of health problems, including type 2 diabetes that formerly afflicted only adults.
To assist physicians in caring for this population, the American Academy of Pediatrics has issued a set of guidelines to provide evidence-based recommendations on managing type 2 diabetes in children ages 10 to 18
. The guidelines are the first of their kind for this age group. The guidelines were written in consultation with the American Diabetes Association, the Pediatric Endocrine Society, the American Academy of Family Physicians, and the Academy of Nutrition and Dietetics. The guidelines are published in the February 2013 issue of Pediatrics and were released online Jan. 28.
The guidelines recommend beginning treatment
with insulin at the time of diagnosis in all patients who are ketotic or in ketoacidosis, markedly hyperglycemic, or in whom the distinction between type 1
and type 2 diabetes
is not clear. In all others, metformin is recommended as first-line therapy, along with a lifestyle modification program including nutrition
and physical activity
The guidelines include recommendations for monitoring pediatric patients’ glycemic control, implementing insulin regimens, and diet and physical activity recommendations.