Type 2 Diabetes Mellitus in Children

 

Am Fam Physician. 2018 Nov 1;98(9):590-594.

  Patient information: See related handout on type 2 diabetes mellitus in children.

Author disclosure: No relevant financial affiliations.

The prevalence of type 2 diabetes mellitus in children and adolescents has increased worldwide over the past three decades. This increase has coincided with the obesity epidemic, and minority groups are disproportionately affected. The American Diabetes Association recommends screening for type 2 diabetes beginning at 10 years of age or the onset of puberty in children who are overweight or obese and have two additional risk factors. Diagnostic criteria include a fasting blood glucose level of 126 mg per dL or greater, a two-hour plasma glucose level of 200 mg per dL or greater during an oral glucose tolerance test, an A1C level of 6.5% or more, or a random plasma glucose level of 200 mg per dL or greater plus symptoms of polyuria, polydipsia, or unintentional weight loss. Management should be focused on a multidisciplinary, family-centered approach. Nutrition and exercise counseling should be started at the time of diagnosis and as a part of ongoing management. Metformin is the first-line therapy in conjunction with lifestyle changes. Insulin therapy should be initiated if there are signs of ketosis or ketoacidosis, or if the patient has significant hyperglycemia (A1C greater than 9% or a random plasma glucose level of 250 mg per dL or greater).

Type 2 diabetes mellitus is characterized by hyperglycemia with insulin resistance and impaired insulin secretion. In contrast with type 1 diabetes, pancreatic beta cell dysfunction in type 2 diabetes is not mediated by an autoimmune process.

WHAT IS NEW ON THIS TOPIC

Type 2 diabetes accounts for one in three newly diagnosed cases of diabetes in U.S. children and adolescents.

Up to 32% of adolescents with type 2 diabetes have hypertension at the time of diagnosis.

The American Diabetes Association recommends that screening for type 2 diabetes begin at 10 years of age or the onset of puberty in children who are overweight and have two additional risk factors.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Management of type 2 diabetes mellitus should be focused on a multidisciplinary, family-centered, culturally appropriate approach.

C

2

Nutritional and exercise counseling should be initiated when type 2 diabetes is diagnosed, then addressed as part of ongoing management.

C

2

Metformin in combination with diet and exercise is first-line therapy in children and adolescents 10 years and older who have type 2 diabetes.

C

2, 19

Insulin therapy must be initiated in children and adolescents with type 2 diabetes if they have signs of ketosis or ketoacidosis.

C

2

Insulin therapy should be initiated in children and adolescents without signs of ketosis or ketoacidosis who have random plasma glucose levels of at least 250 mg per dL (13.9 mmol per L), or whose A1C level is greater than 9%.

C

2, 21

A1C levels should be checked every three months in children and adolescents with type 2 diabetes.

C

2

Comorbidities such as hypertension, hyperlipidemia, nephropathy, and retinopathy should be assessed in children and adolescents with type 2 diabetes.

C

6, 11, 22


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Management of type 2 diabetes mellitus should be focused on a multidisciplinary, family-centered, culturally appropriate approach.

C

2

Nutritional and exercise counseling should be initiated when type 2 diabetes is diagnosed, then addressed as part of ongoing management.

C

2

Metformin in combination with diet and exercise is first-line therapy in children and adolescents 10 years and older who have type 2 diabetes.

C

2, 19

Insulin therapy must be initiated in children and adolescents with type 2 diabetes if they have signs of ketosis or ketoacidosis.

C

2

Insulin therapy should be initiated in children and adolescents without signs of ketosis or ketoacidosis who have random plasma glucose levels of at least 250 mg per dL (13.9 mmol per L), or whose A1C level is greater than 9%.

C

2, 21

A1C levels should be checked every three months in children and adolescents with type 2 diabetes.

C

2

Comorbidities such as hypertension, hyperlipidemia, nephropathy, and retinopathy should be assessed in children and adolescents with type 2 diabetes.

C

6, 11, 22


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

The incidence of type 2 diabetes in children and adolescents has increased worldwide over the past three decades.1 Type 2

The Authors

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HANNA XU, MD, is a core faculty member in the Family Medicine Residency Program at Cook County Health and Hospitals System, Chicago, Ill....

MICHAEL C. VERRE, MD, is an instructor in the Department of Pediatrics at Northwestern University Feinberg School of Medicine, Chicago.

Address correspondence to Hanna Xu, MD, John H. Stroger Hospital of Cook County, 1969 W. Ogden Ave., Chicago, IL 60612 (e-mail: hanna. xu@cookcountyhhs.org). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

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