For the first time ever, the American Academy of Pediatrics (AAP) has issued guidelines for the management of Type 2 diabetes. Until now type 2 diabetes has been considered an adult onset disease, but pediatricians are seeing more and more children either pre-diabetic or fully engaged in Type 2. Many physicians believe that the increase in type 2 diabetes is directly related to the rise in childhood obesity.
Type 1diabetes is a chronic condition that is also known as juvenile diabetes or insulin dependent diabetes. It is often a genetic disease or can be caused by certain viruses. With type 1 diabetes, the pancreas produces little or no insulin. It is not curable but can be managed.
Type 2 diabetes is much more common and is rising rapidly among children and teens. It now accounts for up to one in three new cases between the ages of 10 and 18.
Why has the AAP decided guidelines are now needed? Because type 2 diabetes was once considered an adult disease- not a childhood disease.
"Few providers have been trained in managing type 2 diabetes in children and, to date, few medications have been evaluated for safety and [effectiveness] in children," says co-author Janet Silverstein, MD, professor of pediatrics at the University of Florida and chief of endocrinology at Shands Hospital in Gainesville.
"This is a real issue in the pediatric population. It's something that many of us as pediatricians didn't grow up with because we just didn't see it very often," she says.
Proper diagnosis is paramount to the recommended guidelines. Type 1 or type 2 diabetes diagnoses are not always clear-cut and can take time for an accurate diagnosis.
The guidelines recommend giving insulin to patients if it's not clear whether they have type 1 or type 2 diabetes. If type 2 diabetes is confirmed, lifestyle changes along with the medication metformin are recommended. Metformin and insulin are the only two blood sugar-lowering medications approved for those younger than 18, but others are being studied, Silverstein says.
The panel also recommended that children with type 2 diabetes get their hemoglobin A1c levels measured every three months. The test measures blood sugar levels for the past two or three months.
Managing diabetes can require blood sugar level monitoring many times a day. In general the panel endorses the American Diabetes Association’s guidelines. These guidelines recommend testing three or more times daily for those on insulin and less frequent measurement, including after-meal checks, for those not on insulin.
The panel also made other recommendations including nutrition counseling, moderate to vigorous exercise for at least 60 minutes daily, and limiting screen time at home to less than two hours per day.
Type 2 diabetes doesn’t always exhibit the classic symptoms that type 1 does. Kids with type 2 may not have any symptoms and may not be diagnosed unless they have a yeast infection or a urinary tract infection. However, the medical complications of living with type 2 diabetes are well known. The condition can affect nearly every major organ in your child's body, including the heart, blood vessels, nerves, eyes and kidneys.
Pre-diabetes is easier to manage than treatment for the disease. Pre-diabetes is even more common in overweight children than is diabetes. It’s vital to intervene when a child is gaining too much weight. "It's important to advise parents that it's much easier to prevent type 2 diabetes than to treat it." Silverstein says.
How can you help prevent your child from developing type 2 diabetes? Experts recommend visiting with a registered dietician if you’re concerned about your child’s weight and eating habits. Healthy meals, exercise and weight control are all key factors in diabetes prevention. Studies have shown that lifestyle changes can prevent or delay type 2 diabetes in adults. But experts are not sure whether lifestyle changes will have the same effect in children. Studies on preventing type 2 diabetes, in children and teens, are ongoing. Some clinical trials show that a program of physical activity and healthy eating can decrease insulin resistance and help control blood glucose.