First Ever Guidelines for Managing Type 2 Diabetes in Kids

With the surge of sugary drinks and hydrogenated oils lacing kids' diets, it's no wonder that, according to a 2012 report by the Food Research and Action Center, one-third of all school-age children in the United States are obese.

And the epidemic is fueling an increase in Type 2 diabetes among youth – making it a growing concern for pediatricians and parents alike. Recognizing the connection, in February 2013, the American Academy of Pediatrics released its first-ever guidelines for managing Type 2 diabetes in children and adolescents ages 10-18.

What does it say, and what impact might it have for kids, parents and families here in southeast Michigan?

Breakdown of guidelines

AAP's new advice covers six key points, geared at pediatricians, for treating Type 2 diabetes. Here's an overview of its action statements:

1. Insulin injection treatments: These should be a first line of defense – for certain kids. In particular, this is suggested for youth who are ketotic (their levels of "ketones," tiny molecules located in the blood that are used for energy, are too high) or in diabetic ketoacidosis (a shortage of insulin that causes your child's body to produce acidic ketones). It's also a wise move if doctors haven't yet determined whether your child has Type 1 (high glucose levels) or Type 2 diabetes – or if there are other specific blood glucose problems.

2. Lifestyle modification programs: If insulin-related issues aren't a factor, Type 2 kids need changes in their nutrition and physical activity. Clinicians should also start youth on Metformin, a prescription, oral-based medication used to control blood-sugar levels.

3. Clinical monitoring. Every three months, kids should visit their doctor to get blood sugar concentrations – "HbA1C," more specifically, in med-speak – checked. If certain goals aren't being met, treatment should be intensified.

4. At-home monitoring: Parents should also keep tabs on blood sugar with "finger stick" testing – i.e., poking the child's finger, drawing a drop of blood and getting a reading from it with a home glucose meter (various "lancing devices" and meters are on the market; as your doc). In particular, this is suggested for kids who are: at-risk for hyperglycemia, taking insulin/other meds, changing their diabetes treatment regimen, not meeting treatment goals or have inter-current illnesses.

5. Pro nutrition advice. From the time of a child's Type 2 diagnosis, clinicians should use the Academy of Nutrition and Dietetics' Pediatric Weight Management Evidence-Based Nutrition Practice Guidelines counseling, to help create ongoing treatment for kids.

6. Moderate-to-vigorous exercise. Docs should encourage this in Type 2 kids, too – at least 60 minutes of it per day. Parents should also be limiting children's "nonacademic" screen time to less than two hours per day.

Local doctor's feedback

The AAP's new guidelines give pediatricians a clear-cut plan for helping families treat and manage Type 2 diabetes. That's the opinion of Dr. Charles Barone II, president of the Michigan chapter of the American Academy of Pediatrics and chairman of pediatrics at the Henry Ford Hospital in Detroit.

In the past 20 years, Barone says, Type 2 diabetes – which was largely seen as an "adult illness" – has become prevalent among children and adolescents.

"Most pediatricians will find this very helpful," Barone says of the guidelines. "They've probably been waiting for something like this."

Barone also notes, however, that the emphasis on lifestyle change through nutrition and physical activity is also what makes the advice so effective.

"We preach healthy diet and activity all the time, because of the obesity epidemic," he says. "What this does, however, is it suggests that we should be prescribing (patients) exercise programs. If you can control the illness with oral medicine and get patients exercising and eating healthy, it can be conquered."

While the guidelines are beneficial for pediatricians, Barone adds, he also thinks they're helpful for parents. It gives moms and dads a scientifically backed understanding of what to expect when managing Type 2 diabetes in their children or adolescents, he explains.

Barone did say, however, that he feels that more exposure and breakdown of the guidelines will help make the medical information less daunting for parents.


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