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Guidelines Address Newly Diagnosed Type 2 Diabetes in Children

The American Academy of Pediatrics (AAP) recently released a new set of clinical guidelines for physicians managing newly diagnosed type 2 diabetes in patients up to 18 years of age. The guidelines were published in the February issue of Pediatrics, and encourage the use of insulin as first-line treatment when patients present with ketosis or frank ketoacidosis, and in cases where the "distinction between type 1 and type 2 diabetes is not clear."

In young hyperglycemic patients in whom ketosis or ketoacidosis has not been identified, insulin therapy may also provide a therapeutic benefit, the guidelines state. It may be possible to gradually reduce and then discontinue insulin therapy in many such patients, the report says. For any other newly diagnosed type 2 diabetes patients in this group, the guidelines recommend lifestyle modification and initiation of metformin therapy.

Similar comprehensive guidelines for patients in this young age group have not previously been issued. The guidelines were written in consultation with the AAFP, the American Diabetes Association, the Academy of Nutrition and Dietetics (AND), and the Pediatric Endocrine Society.

Additional suggestions in the guidelines include:

  • encouraging young patients to exercise for 60 minutes daily and to limit "screen time" to under 120 minutes per day;
  • monitoring patientsí HbA1c every three months and intensifying treatment if blood glucose and HbA1c goals are not met;
  • providing dietary and nutritional counseling to young patients that incorporates the ANDís Pediatric Weight Management Evidence-based Nutrition Practice Guidelines; and
  • advising patients who are initiating or changing their diabetes treatment regimen, who are taking insulin or other medications associated with a risk of contracting hypoglycemia, and who have not met treatment goals to monitor blood glucose concentrations.

The full guidelines can be accessed at http://tinyurl.com/be72tee.

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