February 5, 2013

We Now Have Guidelines for Diabetes in Youth

At least the American Academy of Pediatrics (AAP) has issued a set of guidelines to provide evidence-based recommendations on managing type 2 diabetes in children ages 10 to 18. The American Diabetes Association still does not know how to deal with children and adolescents unless they have type 1 diabetes. Type 2 does not seem to be on their list of objectives.

The guidelines are in a PDF file and can be downloaded and opened by Adobe Reader. Then they can be saved to another file. I think what Dr Bill Quick says is worth quoting. “A warning to those of you who might be interested in reading the guidelines: they are very lengthy and very wordy. So don’t expect to be able to hand a copy to your physician and have the doc scan it and comment upon it while you wait… But if your medical team sees kids with diabetes, and isn’t aware of these guidelines, it would be worthwhile to let them know these guidelines exist.”

The files - “Guidelines full text” and “Technical report full text” for downloading can be found here at the end of this Medscape article. I have to be fair and list the other medical organizations that assisted the AAP in developing the guidelines. They were developed with support from the American Diabetes Association, the Pediatric Endocrine Society, the American Academy of Family Physicians, and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association).

Coauthor Janet Silverstein, MD, professor of pediatrics at the University of Florida and chief of endocrinology at Shands Hospital, Gainesville, FL has made some statements to Medscape that are important to be considered. “First is a recommendation for insulin treatment in all patients who present with ketosis or extremely high blood sugar, in whom it may not be clear initially whether they have type 2 or type 1 diabetes. This is important because overweight or obese children are frequently misdiagnosed as having type 2 when in fact they are positive for antibodies associated with type 1.”

Her next statement is more important. “Once type 2 diabetes is confirmed, lifestyle modification along with metformin as first-line therapy is recommended. Metformin and insulin are the only 2 glucose-lowering medications currently approved in youth less than 18 years, but others are being studied.” I would urge everyone to read the Medscape article and consider downloading at least the Guidelines.

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