Childhood obesity has ushered in a variety of health problems that traditionally afflicted adults. Managing one of the conditions, Type 2 diabetes, is the focus of new guidelines from the American Academy of Pediatrics.

When diabetes strikes during childhood, it is routinely assumed to be Type 1, or juvenile-onset, diabetes. However, in the last two decades, Type 2 diabetes (formerly known as adult-onset diabetes) has been reported among U.S. children and adolescents with increasing frequency.

It's now estimated that up to one in three new cases of diabetes diagnosed in individuals under the age of 18 is Type 2 diabetes, the form that until recently was seen primarily in adults. Many physicians simply aren't trained in managing Type 2 diabetes in children, and few of the Type 2 diabetes medications have been evaluated for safety and efficacy in kids, points out Kenneth Copeland, MD, Chief of the Section of Pediatric Diabetes and Endocrinology and director of the Harold Hamm Diabetes Center-Children's at the University of Oklahoma Health Sciences Center.

Children and adolescents diagnosed with Type 2 diabetes generally are between 10 and 18 years old, are obese, have a strong family history for Type 2 diabetes, and have insulin resistance. Those affected with Type 2 diabetes belong to all ethnic groups, but it is more commonly seen in non-white groups.

In contrast to Type 1, Type 2 diabetes in children can go undiagnosed for a long time, because children may have no symptoms or mild symptoms. In addition, it is difficult to be sure it is Type 2, because the criteria for differentiating between types of diabetes in children can sometimes be not so straightforward. Children with Type 2 can develop ketoacidosis (acid build-up in the blood) while children with Type 1 can be overweight and have a strong family history of Type 2.

The guidelines, published in the February 2013 issue of Pediatrics, are the first of their kind for patients this age and were a collaborative effort of the AAP as well as the American Diabetes Association and the Pediatric Endocrine Society, among other organizations.

Here's what's included in the guidelines:

1. It's recommended that patients who are in ketoacidosis or have very high blood sugar (above 250)  start treatment with insulin when diagnosed, Copeland says. Also, children in whom the distinction between Type 1 and Type 2 diabetes is not clear should be started on insulin.

2. In the remainder of patients, metformin (a pill taken twice a day) is recommended as the first-line therapy, Copeland says "along with a lifestyle modification program including nutrition and physical activity."

3. Finger-stick blood glucose monitoring is recommended by the guidelines in patients who take insulin or other medications that can increase the risk of hypoglycemia, who are initiating or changing their diabetes treatment regimen, who haven't met their treatment goals, or who have another illness going on at the same time.

4. Also included are recommendations on the frequency of monitoring blood glucose levels, diet and physical activity, and implementing insulin regimens, Copeland says. The guidelines recommend that children and teenagers with Type 2 diabetes engage in at least one hour of moderate-to-vigorous activity each day and that they limit non-academic "screen time" to less than two hours per day. 

5. As for Copeland's advice to parents, he says: "Preventing Type 2 diabetes (through healthy nutrition and regular exercise as a part of daily living) is far more valuable than knowing optimal methods of diabetes management once it has already developed."

6. If your child has Type 2 diabetes, it is important to be aware that he may have other health conditions as well, says Patricia Vuguin, MD, pediatric endocrinologist at Cohen Children's Medical Center in New Hyde Park, NY.

High blood pressure is common in children with Type 2," she says. "So are significant problems with cholesterol and triglycerides, difficulty breathing at night (snoring), and kidney disease, and there is a higher rate of depression, too. So parents need to be aware of these conditions."

Patricia Vuguin, MD reviewed this article.


Copeland, Kenneth C. et al. "Management of newly diagnosed Type 2 diabetes mellitus in children." Pediatrics. 28 January 2013.