In response to the ongoing epidemic of Type 2 diabetes in children, the American Association of Pediatrics has for the first time released guidelines on how to treat the condition in people ages 10–18. According to the American Diabetes Association, 1 out of every 400 children and adolescents in the United States has Type 2.
Type 1 diabetes involves destruction of the insulin-producing beta cells of the pancreas, and requires insulin as a treatment, while Type 2 diabetes often initially requires only oral medicines. Because it can be very difficult to immediately tell if a child has Type 1 or Type 2 diabetes, and because it can take weeks to obtain the results of the antibody tests that can definitively distinguish between the two conditions, the first step in treating a child with diabetes is to start insulin, according to the new guidelines. The child should continue using insulin until the type of diabetes he has can be conclusively determined.
Once a child has been diagnosed with Type 2 diabetes, he should be started on the oral diabetes drug metformin and encouraged to adopt a better diet and become more physically active. The child should aim for at least 60 minutes a day of exercise and limit his nonacademic screen time (watching television, playing video games, and so on) to less than two hours each day.
Doctors should monitor the child’s A1C level (a measure of glucose control over the previous 2–3 months) every three months and make changes to treatment as needed based on the results. Home blood glucose monitoring should be used by any child who is using insulin, not meeting his treatment goals, changing treatment regimens, and during times of illness.
“Pediatricians and pediatric endocrinologists are used to dealing with Type 1 diabetes. Most have had no formal training in the care of children with Type 2,” noted Janet Silverstein, MD, one of the authors of the guidelines. “The major reason for the guidelines is that there’s been an increase in overweight and obesity in children and adolescents, with more Type 2 diabetes in that population, making it important for general pediatricians as well as endocrinologists to have structured guidelines to follow.”
Dr. Silverstein further notes that pediatricians should monitor A1C levels in overweight children in an effort to prevent Type 2 diabetes before it develops. Inflammation of the tube that drains to the bladder and yeast infections in girls should be considered possible signs of diabetes.