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, and an accompanying technical report, 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.
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The American Academy of Pediatrics is an
organization of 60,000 primary care pediatricians, pediatric medical
subspecialists and pediatric surgical specialists dedicated to the health,
safety and well-being of infants, children, adolescents and young adults. (www.aap.org)
