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TYPE 2 DIABETES IN CHILDREN AND ADOLESCENTS

TYPE 2 DIABETES IN CHILDREN AND ADOLESCENTS. 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. TYPE 2 DIABETES IN CHILDREN. Type 2 diabetes in children and adolescents has been documented in both Aboriginal and other populations in North America.

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TYPE 2 DIABETES IN CHILDREN AND ADOLESCENTS

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  1. TYPE 2 DIABETES IN CHILDRENAND ADOLESCENTS 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada

  2. TYPE 2 DIABETES IN CHILDREN • Type 2 diabetes in children and adolescents has been documented in both Aboriginal and other populations in North America. • The prevalence of type 2 diabetes in Canadian Aboriginal children aged 5 to 18 years has been documented to be as high as 1% with the highest prevalence in the plains Cree people of central Canada.

  3. TYPE 2 DIABETES IN CHILDREN • Risk factors for the development of type 2 diabetes in children and adolescents include: • Family history of type 2 diabetes • Member of a high-risk ethnic population • Overweight • IGT • Exposure to diabetes in utero • PCOS • Acanthosis nigricans • Hypertension • Dyslipidemia

  4. CLASSIFICATION • In most children, the mode of presentation and early course of the disease indicate whether the child has type 1 or type 2 diabetes. In some cases, differentiation can be difficult. Testing for islet antibodies may be useful. Fasting insulin is not helpful as these levels are usually low. • Youth with type 2 diabetes can present in diabetic ketoacidosis (DKA) and this cannot be used to classify the type of diabetes. Clinical phenotype is usually most helpful. DNA diagnostic testing may be considered in some populations.

  5. PREVENTION AND MANAGEMENT • Obesity is a major modifiable risk factor for the development of type 2 diabetes, yet studies on prevention of obesity in children are limited. • Children with type 2 diabetes should receive care from an interdisciplinary pediatric diabetes team. • Intensive lifestyle intervention in obese youth with type 2 diabetes should be the first line of therapy, unless there is severe metabolic decompensation. • Insulin is required in those with severe metabolic decompensation (e.g. DKA, A1C  9%). • Metformin may be useful in the short term to improve glycemic control.

  6. COMPLICATIONS • Evidence suggests that early-onset type 2 diabetes in adolescence leads to severe and early-onset microvascular complications. • It is prudent to consider screening for retinopathy at diagnosis. • There is good evidence to support screening for renal disease at diagnosis. Aboriginal youth are at increased risk of diabetic and nondiabetic renal disease. • Surveillance for co-morbid features of the metabolic syndrome (hypertension, dyslipidemia) should occur at diagnosis, and periodically thereafter.

  7. TYPE 2 DIABETES IN CHILDREN - RECOMMENDATIONS • Obese children  10 years of age should be considered for screening for type 2 diabetes every 2 years using an FPG test if they meet 2 of the following criteria: • member of a high-risk ethnic group • family history of type 2 diabetes, especially if the child was exposed to diabetes in utero • acanthosis nigricans • PCOS • hypertension • dyslipidemia An OGTT may also be considered as a screening test [Grade D, Consensus].

  8. TYPE 2 DIABETES IN CHILDREN- RECOMMENDATIONS • Adolescents with type 2 diabetes should receive intensive counselling regarding lifestyle modification. If glycemic targets are not achieved using lifestyle modification alone, metformin [Grade B, Level 2] or insulin should be considered [Grade D, Consensus].

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