The current childhood obesity epidemic has led to the American Academy of Pediatrics publishing new guidelines, for the first time ever, for doctors to follow in managing type 2 diabetes in patients between the ages of 10 and 18.
Type 2 diabetes affects 90 to 95 percent of the 26 million American adult diabetics, but it had been rare in children and adolescents. As childhood obesity rates have skyrocketed, one in three children younger than 18 diagnosed with diabetes is now diagnosed with type 2.
Few doctors have been trained to manage type 2 in children, and until now, few studies have been done on pediatric type 2; few medications have been evaluated to determine safety and efficacy in children with type 2.
The new clinical practice guidelines addressing pediatric type 2 were published in the February, 2013 issue of Pediatrics, published online on January 28, 2013. Doctors who authored the guidelines recommend to their colleagues that when it is unknown whether a young patient has type 1 or type 2 diabetes, insulin treatment be used for all patients with very high blood sugar or with ketosis (ketosis involves high levels of ketones in the blood — small particles that indicate that the body is burning fat, instead of carbohydrates, for energy).
Once it is established that patient has type 2, insulin treatment can be stopped, and treatment can then consist of lifestyle changes, as well as the drug Metformin.
The recommendations call for youths with type 2 diabetes to get one hour’s worth of daily moderate-to-vigorous exercise, and to limit non-school-related computer use to less than two hours a day. Primary care doctors are advised to be on alert for type 2 cases in their young patients, as type 2 symptoms are not as obvious as type 1 symptoms, and the onset of type 2 diabetes is more gradual.
Prediabetes is more common in overweight youth than full diabetes, so the doctors advise that it’s important to intervene when it becomes obvious that a child is gaining excess weight; it is easier to prevent type 2 diabetes than it is to treat it.
The guidelines also call for coordination between the primary care physician, a specialist, an nutritionist and other professionals who may be needed, such as a psychologist or social worker to help implement necessary lifestyle/behavioral changes.
Type 1 diabetes, usually diagnosed in children and young adults, results from an autoimmune reaction in which the body attacks and destroys pancreatic cells that produce insulin; the body is therefore unable to produce insulin (insulin is responsible for causing various cells in the body to take up glucose from the blood and convert it to energy).
Type 2 diabetes results from muscles and other tissues in the body developing a resistance to the insulin produced by the pancreas. The pancreas compensates by making more insulin; blood sugar goes up, as the body is unable to make enough insulin. Symptoms of type 2 include glucose in the urine, low energy, a discharge from the penis or vaginal yeast infections, frequent urination, and excess thirst.
Type 2 diabetes can be prevented by maintaining a normal weight and eating a healthy diet. To avoid unhealthful weight gain, doctors recommend that children eat healthier, smaller food portions. Whole foods are always better than processed foods; a diet rich in vegetables, fruits, healthy low-fat proteins and grains, and low in sugar, will help keep everyone, of any age, healthy.
Medical experts agree that medications alone can only do so much for type 2 diabetes; lifestyle changes — more physical activity and a healthful diet — are key to maintaining or regaining good health.
By Marc Courtoil