Materiały źródłowe

• #1 Type 2 diabetes in children – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/type-2-diabetes-in-children/diagnosis-treatment/drc-20355324

  Treatment for type 2 diabetes is lifelong and can include: […] You’ll work closely with your child’s diabetes treatment team including a health care provider, certified diabetes care and education specialist, registered dietitian, and other specialists as needed. The goal of treatment is to keep your child’s blood sugar within a certain range. […] Your child’s health care provider will let you know what your child’s blood sugar target range is, and may also set an A1C target. […] Food is a big part of any diabetes treatment plan, but that doesn’t mean your child has to follow a strict „diabetes diet.” […] Your child’s dietitian will likely suggest that your child and the rest of the family consume foods that are high in nutritional value and low in fat and calories. […] Healthy eating includes a diet high in fruits, vegetables, nuts, whole grains and olive oil.

• #2 Pediatric Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Proposed Management Algorithm

  https://emedicine.medscape.com/article/925700-treatment

  Ideally, management of diabetes should involve a pediatric endocrinologist, a diabetes nurse educator, a nutritionist, and a behavioral specialist. […] The American Academy of Pediatrics (AAP) issued clinical practice guidelines on the management of type 2 diabetes in children and adolescents. The guidelines recommend insulin treatment in all patients who present with ketosis or extremely high blood glucose levels because it may not be clear initially whether these patients have type 2 or type 1 diabetes. Once a diagnosis of type 2 diabetes is confirmed, lifestyle modification and metformin treatment should be initiated. […] The goal of therapy is to achieve and maintain euglycemia, as well as near-normal hemoglobin A1c (HbA1c) levels (7%). Patients who are not ill at diagnosis can be treated initially with lifestyle changes (eg, diet, exercise, weight control). However, because few patients can maintain euglycemia with lifestyle changes alone, most children and adolescents require medication.

• #3 A practical evidence-based approach to management of type 2 diabetes in children and young people (CYP): UK consensus | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03349-4

  Type 2 diabetes in young people is an aggressive disease with a greater risk of complications leading to increased morbidity and mortality during the most productive years of life. […] Young people with type 2 diabetes should be managed within a paediatric diabetes team with close working with adult diabetes specialists, primary care and other paediatric specialties. […] Lifestyle change and metformin are the mainstay of early treatment, with some needing additional basal insulin. GLP1 agonists should be used as second-line agents once early ketosis and symptoms are controlled. […] This evidence-based guideline aims to provide a practical approach in managing this condition in the UK. […] We recommend HbA1c testing as the primary test for screening for type 2 diabetes. […] We recommend that HbA1c is tested every 3 months with an overall target of 6.5% (48 mmol/mol) which should be individualised based on circumstances.

• #4 Treatment options and current guidelines of care for pediatric type 2 diabetes patients: a narrative review

  https://www.degruyter.com/document/doi/10.1515/jom-2020-0172/html?lang=en

  Type 2 diabetes (T2D) mellitus, which was once considered a disease affecting adults, is a growing problem among youths. […] There are very limited treatment options available to manage pediatric T2D. […] Prevention of pediatric T2D is paramount, which requires a high index of suspicion, routine screening of children and adolescents, and willingness to engage in family-based interventions for those at risk for prediabetes and T2D. […] Youth-onset T2D is more virulent and more progressive than adult-onset T2D, meaning that a gentle and progressive-intensity approach is less likely to be successful. Instead, treatment should start immediately upon diagnosis. […] The ADA recommends initiating comprehensive lifestyle programs and diabetes education for families, with a goal of 7-10% decrease in body weight.

• #5 Pediatric Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Proposed Management Algorithm

  https://emedicine.medscape.com/article/925700-treatment

  Ideally, management of diabetes should involve a pediatric endocrinologist, a diabetes nurse educator, a nutritionist, and a behavioral specialist. […] The American Academy of Pediatrics (AAP) issued clinical practice guidelines on the management of type 2 diabetes in children and adolescents. The guidelines recommend insulin treatment in all patients who present with ketosis or extremely high blood glucose levels because it may not be clear initially whether these patients have type 2 or type 1 diabetes. Once a diagnosis of type 2 diabetes is confirmed, lifestyle modification and metformin treatment should be initiated. […] The goal of therapy is to achieve and maintain euglycemia, as well as near-normal hemoglobin A1c (HbA1c) levels (7%). Patients who are not ill at diagnosis can be treated initially with lifestyle changes (eg, diet, exercise, weight control). However, because few patients can maintain euglycemia with lifestyle changes alone, most children and adolescents require medication.

• #6 Management of type 2 diabetes mellitus in children and adolescents – UpToDate

  https://www.uptodate.com/contents/management-of-type-2-diabetes-mellitus-in-children-and-adolescents

  Management of type 2 diabetes mellitus in children and adolescents […] The largest clinical trial, Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY study), has shown that oral agent monotherapy does not maintain durable glycemic control in a majority of patients with adolescent-onset T2DM. […] It is important to optimize treatment using a combination of pharmacologic and nonpharmacologic interventions, with close monitoring and follow-up. […] Ideally, the care of an adolescent with T2DM should be managed by a multidisciplinary team, including an endocrinologist, nurse educator, dietitian, mental health professional, and sometimes an exercise physiologist. […] Patients who do not achieve good glycemic control on metformin monotherapy should be managed by or in consultation with an endocrinologist and diabetes educator, if at all possible. […] Family involvement is essential to initiate and support the lifestyle changes required in the management of a pediatric patient with this disorder. […] The management of T2DM in children and adolescents is presented here.

• #7 A practical evidence-based approach to management of type 2 diabetes in children and young people (CYP): UK consensus | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03349-4

  Type 2 diabetes in young people is an aggressive disease with a greater risk of complications leading to increased morbidity and mortality during the most productive years of life. […] Young people with type 2 diabetes should be managed within a paediatric diabetes team with close working with adult diabetes specialists, primary care and other paediatric specialties. […] Lifestyle change and metformin are the mainstay of early treatment, with some needing additional basal insulin. GLP1 agonists should be used as second-line agents once early ketosis and symptoms are controlled. […] This evidence-based guideline aims to provide a practical approach in managing this condition in the UK. […] We recommend HbA1c testing as the primary test for screening for type 2 diabetes. […] We recommend that HbA1c is tested every 3 months with an overall target of 6.5% (48 mmol/mol) which should be individualised based on circumstances.

• #8 Type 2 diabetes mellitus in children and adolescents

  https://www.racgp.org.au/afp/2016/june/type-2-diabetes-mellitus-in-children-and-adolescen

  The management of paediatric T2DM is complex as it involves managing the comorbidities associated with diabetes and obesity. […] The three main goals in the management of T2DM in children and adolescents are lifestyle modification, normalisation of glycaemia and management of comorbidities. […] Although lifestyle (dietary and exercise) modifications are crucial to the management of T2DM, less than 10% of youth with T2DM will reach their glycaemic targets with lifestyle modifications alone. […] Youth with confirmed T2DM are usually treated with metformin and/or insulin therapy, which is determined by symptoms, severity of hyperglycaemia and presence of ketosis. […] The overall goal of initial treatment is to achieve an HbA1c of 6.5%. […] Youth with newly diagnosed T2DM have a high prevalence of complications relating to diabetes and obesity at presentation.

• #9 A Review of the Treatment of Type 2 Diabetes in Children

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4353199/

  The incidence of type 2 diabetes and obesity in children and adolescents has risen at staggering rates. […] Recently, the American Diabetes Association and the Pediatric Endocrine Society have collaborated to create a guideline for the treatment of type 2 diabetes in children. Similar to the treatment of adults with type 2 diabetes, metformin remains the mainstay of therapy along with diet and exercise. […] Treatment of T2DM should be focused on decreasing complications in children and adolescents. […] Few studies exist in children with T2DM; however, data from studies in children with T1DM and adults with T2DM suggest that tight glycemic control reduces the risk of microvascular complications. […] Treatment of every child with T2DM should begin with lifestyle modifications, including physical activity and nutrition.

• #10 Type 2 diabetes in children – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/type-2-diabetes-in-children/diagnosis-treatment/drc-20355324

  Treatment for type 2 diabetes is lifelong and can include: […] You’ll work closely with your child’s diabetes treatment team including a health care provider, certified diabetes care and education specialist, registered dietitian, and other specialists as needed. The goal of treatment is to keep your child’s blood sugar within a certain range. […] Your child’s health care provider will let you know what your child’s blood sugar target range is, and may also set an A1C target. […] Food is a big part of any diabetes treatment plan, but that doesn’t mean your child has to follow a strict „diabetes diet.” […] Your child’s dietitian will likely suggest that your child and the rest of the family consume foods that are high in nutritional value and low in fat and calories. […] Healthy eating includes a diet high in fruits, vegetables, nuts, whole grains and olive oil.

• #11 Type 2 diabetes in children – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/type-2-diabetes-in-children/symptoms-causes/syc-20355318

  Teaching your child the importance of healthy eating and participating in regular physical activity […] Scheduling regular visits with your child’s diabetes treatment team. […] Healthy-lifestyle choices can help prevent type 2 diabetes in children. Encourage your child to: […] Eat healthy foods. Offer your child foods low in fat and calories. Focus on fruits, vegetables and whole grains. Strive for variety to prevent boredom. […] Get more physical activity. Encourage your child to become active. Sign up your child for a sports team or dance lessons.

• #12 Type 2 diabetes in children – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/type-2-diabetes-in-children/diagnosis-treatment/drc-20355324

  Treatment for type 2 diabetes is lifelong and can include: […] You’ll work closely with your child’s diabetes treatment team including a health care provider, certified diabetes care and education specialist, registered dietitian, and other specialists as needed. The goal of treatment is to keep your child’s blood sugar within a certain range. […] Your child’s health care provider will let you know what your child’s blood sugar target range is, and may also set an A1C target. […] Food is a big part of any diabetes treatment plan, but that doesn’t mean your child has to follow a strict „diabetes diet.” […] Your child’s dietitian will likely suggest that your child and the rest of the family consume foods that are high in nutritional value and low in fat and calories. […] Healthy eating includes a diet high in fruits, vegetables, nuts, whole grains and olive oil.

• #13 A Review of the Treatment of Type 2 Diabetes in Children

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4353199/

  The AAP guideline recommends clinicians incorporate Academy of Nutrition and Dietetics’ Pediatric Weight Management Evidence-Based Nutrition Practice Guidelines into their patient education and counseling. […] The use of exogenous insulin helps regulate serum glucose by increasing its uptake into muscle and adipose tissue and decreasing hepatic glucose production. […] The following insulin types are indicated for use in children: aspart, glulisine, lispro, regular, neutral protamine Hagedorn (NPH), detemir, and glargine. […] Unless there are contraindications, all children with T2DM should be started on metformin. […] Clinical evidence supporting the use of metformin in pediatric patients is limited. […] The most common adverse events associated with metformin are gastrointestinal upset, including abdominal pain and diarrhea.

• #14 Type 2 diabetes in children – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/type-2-diabetes-in-children/diagnosis-treatment/drc-20355324

  Everyone needs regular aerobic exercise, and children who have type 2 diabetes are no exception. […] There are three medications that have been approved by the Food and Drug Administration (FDA) for treating type 2 diabetes in children. […] Sometimes, insulin may be needed if your child’s blood sugar levels are very high. […] Your health care provider will let you know how often you or your child need to check and record your child’s blood sugar. […] These procedures are not an option for everyone. But for teens who are significantly obese a body mass index (BMI) at or above 35 having weight-loss surgery may lead to improved management of type 2 diabetes. […] Your child will need regular appointments to ensure good diabetes management. […] Healthy-lifestyle changes can reduce the need for medications. […] Your health care provider may check your child’s A1C levels. […] If you suspect hyperglycemia, check your child’s blood sugar. […] Living with type 2 diabetes isn’t easy for you or for your child. Good diabetes management requires a lot of changes, especially in the beginning.

• #15 Type 2 Diabetes Mellitus in Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1101/p590.html

  Management of type 2 diabetes should be focused on a multidisciplinary, family-centered, culturally appropriate approach. […] Clinicians should focus on nutritional counseling for children with type 2 diabetes at the time of diagnosis and as a part of ongoing management. […] Exercise counseling should also be addressed at the time type 2 diabetes is diagnosed and as a part of ongoing management. […] Metformin and insulin are the only medications for type 2 diabetes that are approved by the U.S. Food and Drug Administration for use in children and adolescents. […] Although newly diagnosed type 2 diabetes may respond to metformin and lifestyle changes, insulin therapy must be initiated if the patient has signs of ketosis or ketoacidosis. […] The American Academy of Pediatrics recommends that clinicians monitor A1C levels every three months in children and adolescents with type 2 diabetes.

• #16 Type 2 diabetes in children – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/type-2-diabetes-in-children/symptoms-causes/syc-20355318

  Teaching your child the importance of healthy eating and participating in regular physical activity […] Scheduling regular visits with your child’s diabetes treatment team. […] Healthy-lifestyle choices can help prevent type 2 diabetes in children. Encourage your child to: […] Eat healthy foods. Offer your child foods low in fat and calories. Focus on fruits, vegetables and whole grains. Strive for variety to prevent boredom. […] Get more physical activity. Encourage your child to become active. Sign up your child for a sports team or dance lessons.

• #17 Child Type 2 Diabetes: Symptoms, Causes & Treatments

  https://www.webmd.com/diabetes/type-2-diabetes-in-children

  The same steps used to treat type 2 diabetes in children can also prevent it. Reduce calories, processed starchy foods, unhealthy fats, and sweets in your child’s diet. Make sure they get physical activity each day. Studies show that exercise has a dramatic effect on reducing insulin resistance. These are two important ways to help your child get down to and stay at a healthy weight and normal blood sugar levels.

• #18 Management of Type 2 Diabetes in Youth: An Update | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0901/p658.html

  Metformin (Glucophage) is an oral medication approved for use in some children. […] The insulin may be tapered to discontinuation if metabolic control is maintained. […] Treatment regimens (e.g., blood glucose goals, frequency of self-monitoring, type of insulin, dose and frequency of insulin administration, use of injections or a pump, nutritional management, physical activity levels) vary among patients. […] The diabetes care team should determine the regimen that best suits the patient’s individual characteristics and circumstances. […] The increase in overweight in youths has been associated with increased consumption of beverages with a high sugar content, long hours watching television, and reduced physical activity. […] Children with a BMI greater than the 85th percentile for age and sex should be counseled to increase physical activity and reduce weight gain while allowing for normal growth and development.

• #19 Treatment options and current guidelines of care for pediatric type 2 diabetes patients: a narrative review

  https://www.degruyter.com/document/doi/10.1515/jom-2020-0172/html?lang=en

  Type 2 diabetes (T2D) mellitus, which was once considered a disease affecting adults, is a growing problem among youths. […] There are very limited treatment options available to manage pediatric T2D. […] Prevention of pediatric T2D is paramount, which requires a high index of suspicion, routine screening of children and adolescents, and willingness to engage in family-based interventions for those at risk for prediabetes and T2D. […] Youth-onset T2D is more virulent and more progressive than adult-onset T2D, meaning that a gentle and progressive-intensity approach is less likely to be successful. Instead, treatment should start immediately upon diagnosis. […] The ADA recommends initiating comprehensive lifestyle programs and diabetes education for families, with a goal of 7-10% decrease in body weight.

• #20 Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Management of Glycemia

  https://emedicine.medscape.com/article/117853-treatment

  Aggressive glucose lowering may not be the best strategy in all patients. Individual risk stratification is highly recommended. […] A study by Morrison et al found that more frequent visits with a primary care provider (every 2 wk) led to markedly rapid reductions in serum glucose, HbA1c, and low-density lipoprotein (LDL) cholesterol levels. […] In a 2021 joint consensus statement from the ADA, the Endocrine Society, the European Association for the Study of Diabetes, and Diabetes UK, the term remission, as it applies to type 2 diabetes, is defined as the presence of an HbA1c level below 6.5% ( 48 mmol/mol) at least 3 months after glucose-lowering pharmacotherapy has been halted. […] Early initiation of pharmacologic therapy is associated with improved glycemic control and reduced long-term complications in type 2 diabetes.

• #21 Type 2 diabetes in children – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/type-2-diabetes-in-children/diagnosis-treatment/drc-20355324

  Everyone needs regular aerobic exercise, and children who have type 2 diabetes are no exception. […] There are three medications that have been approved by the Food and Drug Administration (FDA) for treating type 2 diabetes in children. […] Sometimes, insulin may be needed if your child’s blood sugar levels are very high. […] Your health care provider will let you know how often you or your child need to check and record your child’s blood sugar. […] These procedures are not an option for everyone. But for teens who are significantly obese a body mass index (BMI) at or above 35 having weight-loss surgery may lead to improved management of type 2 diabetes. […] Your child will need regular appointments to ensure good diabetes management. […] Healthy-lifestyle changes can reduce the need for medications. […] Your health care provider may check your child’s A1C levels. […] If you suspect hyperglycemia, check your child’s blood sugar. […] Living with type 2 diabetes isn’t easy for you or for your child. Good diabetes management requires a lot of changes, especially in the beginning.

• #22 A Review of the Treatment of Type 2 Diabetes in Children

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4353199/

  The AAP guideline recommends clinicians incorporate Academy of Nutrition and Dietetics’ Pediatric Weight Management Evidence-Based Nutrition Practice Guidelines into their patient education and counseling. […] The use of exogenous insulin helps regulate serum glucose by increasing its uptake into muscle and adipose tissue and decreasing hepatic glucose production. […] The following insulin types are indicated for use in children: aspart, glulisine, lispro, regular, neutral protamine Hagedorn (NPH), detemir, and glargine. […] Unless there are contraindications, all children with T2DM should be started on metformin. […] Clinical evidence supporting the use of metformin in pediatric patients is limited. […] The most common adverse events associated with metformin are gastrointestinal upset, including abdominal pain and diarrhea.

• #23 Treating Type 2 Diabetes in Children – Learning About Diabetes | Diabetes Self-Management

  https://www.diabetesselfmanagement.com/about-diabetes/diabetes-kids/treating-type-2-diabetes-in-children/

  How a child with Type 2 diabetes is treated depends on his diabetes control, any changes in that control, and the results of regular blood glucose monitoring at home and regular checkups by his physician. […] A healthful diet and exercise are the cornerstones of any diabetes care regimen. […] If diet and exercise alone are not enough to control your child’s diabetes or if your child is very ill at diagnosis, your health-care team will probably add insulin, an oral diabetes medicine, or both to your child’s regimen. […] Children newly diagnosed with Type 2 diabetes after a bout of ketoacidosis or hyperglycemic hyperosmolar syndrome are initially treated with insulin. […] Over time, however, a child’s treatment may change. […] Metformin (brand name Glucophage) is currently the only oral diabetes medicine approved by the Food and Drug Administration for use in children.

• #24 Type 2 Diabetes in Children | Duke Health

  https://www.dukehealth.org/pediatric-treatments/pediatric-endocrinology/type-2-diabetes-children

  Every child with Type 2 diabetes has unique needs and circumstances. Duke Children diabetes experts customize your childs treatment to offer the care, support, and information your family needs. […] To manage your childs type 2 diabetes, our diabetes team will provide guidance about eating, drinking, and exercise habits. Some children with type 2 diabetes also benefit from medicines or insulin injections to help manage their blood sugars. […] Diabetes changes over time, so your child’s care team will adapt your child’s treatment plan as needed. […] Metformin lowers the amount of sugar released by the liver into the bloodstream. It increases the effect of insulin, which helps lower blood sugar. […] While many children with type 2 diabetes do not need to use insulin, daily insulin injections may be necessary to manage daily blood sugar levels.

• #25 Treatment of diabetes in children (Review)

  https://www.spandidos-publications.com/10.3892/etm.2016.3039

  Type 2 diabetes (T2D) mellitus has been on the increase in young individuals, and is correlated with the increase in childhood obesity. […] Usually, in both children and adults, T1D is treated with insulin while T2D is treated with metformin. […] In this review, we outline the current pathology and treatment and future therapies of T1D mellitus and T2D mellitus in children. […] Children with T2D are almost always started on metformin. Metformin is a drug that is classified as a biguanide. This drug functions by reducing glucose production and by activating glucose uptake in peripheral tissues. Metformin is administered in children at a 500 mg dose, and is ingested at meal times daily. The dose is increased by 500 mg each week until the dose equals 2,000 mg. […] Clinical trials have shown that the use of metformin is safe for T2D pediatric patients.

• #26 A practical evidence-based approach to management of type 2 diabetes in children and young people (CYP): UK consensus | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03349-4

  We recommend that self-monitoring of blood glucose is undertaken in all patients in line with other international guidelines. […] We recommend that CYP should be managed by multi-disciplinary secondary care teams with close integration with primary care and collaboration with adult diabetes teams. […] Lifestyle change is the cornerstone of type 2 diabetes management. […] Metformin should be started once any ketosis has resolved, starting at a low dose to minimise side-effects and titrated to a maximum of 2 g per day, or the maximum tolerated dose. […] Failure to achieve goal HbA1c with metformin monotherapy should prompt consideration of second-line treatment with liraglutide. […] Bariatric surgery in adolescents leads to successful weight loss in those with severe obesity (BMI35 kg/m2) and demonstrates greater weight loss outcomes when compared with lifestyle and liraglutide.

• #27 A Review of the Treatment of Type 2 Diabetes in Children

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4353199/

  The AAP guideline recommends clinicians incorporate Academy of Nutrition and Dietetics’ Pediatric Weight Management Evidence-Based Nutrition Practice Guidelines into their patient education and counseling. […] The use of exogenous insulin helps regulate serum glucose by increasing its uptake into muscle and adipose tissue and decreasing hepatic glucose production. […] The following insulin types are indicated for use in children: aspart, glulisine, lispro, regular, neutral protamine Hagedorn (NPH), detemir, and glargine. […] Unless there are contraindications, all children with T2DM should be started on metformin. […] Clinical evidence supporting the use of metformin in pediatric patients is limited. […] The most common adverse events associated with metformin are gastrointestinal upset, including abdominal pain and diarrhea.

• #28 Type 2 Diabetes Mellitus in Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1101/p590.html

  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. […] 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 must be initiated in children and adolescents with type 2 diabetes if they have signs of ketosis or ketoacidosis. […] Metformin in combination with diet and exercise is first-line therapy in children and adolescents 10 years and older who have type 2 diabetes. […] 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%.

• #29 Type 2 Diabetes Mellitus in Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1101/p590.html

  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. […] 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 must be initiated in children and adolescents with type 2 diabetes if they have signs of ketosis or ketoacidosis. […] Metformin in combination with diet and exercise is first-line therapy in children and adolescents 10 years and older who have type 2 diabetes. […] 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%.

• #30 A Review of the Treatment of Type 2 Diabetes in Children

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4353199/

  The AAP guideline recommends clinicians incorporate Academy of Nutrition and Dietetics’ Pediatric Weight Management Evidence-Based Nutrition Practice Guidelines into their patient education and counseling. […] The use of exogenous insulin helps regulate serum glucose by increasing its uptake into muscle and adipose tissue and decreasing hepatic glucose production. […] The following insulin types are indicated for use in children: aspart, glulisine, lispro, regular, neutral protamine Hagedorn (NPH), detemir, and glargine. […] Unless there are contraindications, all children with T2DM should be started on metformin. […] Clinical evidence supporting the use of metformin in pediatric patients is limited. […] The most common adverse events associated with metformin are gastrointestinal upset, including abdominal pain and diarrhea.

• #31 A Review of the Treatment of Type 2 Diabetes in Children

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4353199/

  The use of insulin early in the disease process allows glucose concentrations to normalize while – cells are provided a chance to rest and recover. […] Guidelines from the AAP and the International Society for Pediatric and Adolescent Diabetes Consensus Guidelines are clear about when to use insulin or metformin. […] The AAP guideline recommends metformin or insulin as first-line therapy in children with a diagnosis of T2DM, depending upon clinical presentation. […] Lifestyle interventions including exercise and nutrition should be the cornerstone of therapy.

• #32 Pediatric Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Proposed Management Algorithm

  https://emedicine.medscape.com/article/925700-treatment

  Insulin therapy is indicated in symptomatic patients with persistent hyperglycemia, the presence of an HbA1c of more than 9%, or ketoacidosis. After blood glucose levels are normalized, efforts to taper insulin with progressive substitution of an oral agent are undertaken. […] Pharmacologic therapy is indicated when the disease is not well controlled with diet and exercise. Metformin should be the first oral agent used in children and teenagers with an HbA1c level of less than 9%. If metformin is unsuccessful as monotherapy, the addition of insulin, a sulfonylurea, or another hypoglycemic agent may be appropriate. […] In 2019, the US Food and Drug Administration (FDA) approved liraglutide for children aged 10 years or older with type 2 diabetes mellitus. […] Another GLP-1 agonist, exenatide injectable suspension (Bydureon, Bydureon BCise), gained FDA approval for T2DM in children aged 10 years and older in 2021.

• #33 FDA approves new treatment for pediatric patients with type 2 diabetes | FDA

  https://www.fda.gov/news-events/press-announcements/fda-approves-new-treatment-pediatric-patients-type-2-diabetes

  The U.S. Food and Drug Administration today approved Victoza (liraglutide) injection for treatment of pediatric patients 10 years or older with type 2 diabetes. […] Victoza has now been shown to improve blood sugar control in pediatric patients with type 2 diabetes. […] The efficacy and safety of Victoza for reducing blood sugar in patients with type 2 diabetes was studied in several placebo-controlled trials in adults and one placebo-controlled trial with 134 pediatric patients 10 years and older for more than 26 weeks. Approximately 64% of patients in the pediatric study had a reduction in their hemoglobin A1c (HbA1c) below 7% while on Victoza, compared to only 37% who achieved these results with the placebo. […] Pediatric patients 10 years and older taking Victoza had a higher risk of hypoglycemia regardless of whether they took other therapies for diabetes.

• #34 New treatment for children with type 2 diabetes | European Medicines Agency (EMA)

  https://www.ema.europa.eu/en/news/new-treatment-children-type-2-diabetes

  EMAs human medicines committee (CHMP) has recommended granting an extension of indication to Victoza (liraglutide) to include the treatment of children and adolescents aged 10 years or older with type 2 diabetes. […] The recommended treatment for paediatric type 2 diabetes is similar to that in adults, with emphasis on a step-wise approach starting with lifestyle modifications, particularly healthy eating and exercise, followed by the use of a single medical therapy and later by two therapies in combination. […] Currently, the only two approved treatment options for paediatric type 2 diabetes patients in most countries are metformin and insulin. […] Therefore, there is a medical need for alternative treatment options for children and adolescents with type 2 diabetes. […] Victoza is the first non-insulin, besides metformin, to get a positive opinion for paediatric use for type 2 diabetes.

• #35 FDA Approves New Class of Medicines to Treat Pediatric Type 2 Diabetes | FDA

  https://www.fda.gov/news-events/press-announcements/fda-approves-new-class-medicines-treat-pediatric-type-2-diabetes

  Today, the U.S. Food and Drug Administration approved Jardiance (empagliflozin) and Synjardy (empagliflozin and metformin hydrochloride) as additions to diet and exercise to improve blood sugar control in children 10 years and older with type 2 diabetes. […] These approvals provide a new class of medicines taken by mouth to treat pediatric type 2 diabetes. […] Todays approvals provide much-needed additional treatment options for children with type 2 diabetes. […] The safety and efficacy of empagliflozin in children were studied in a double-blind, randomized, placebo-controlled trial in 157 patients aged 10 to 17 years with inadequately controlled type 2 diabetes. […] The trial found that, at week 26, treatment with empagliflozin was superior in reducing hemoglobin A1c, a measure of average blood sugar, compared to placebo.

• #36 Pediatric Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Proposed Management Algorithm

  https://emedicine.medscape.com/article/925700-treatment

  Canagliflozin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor, was approved by the FDA for use in pediatric patients aged 10 years and older with type 2 diabetes mellitus in December 2024. […] Diabetes education is indicated, including lifestyle changes to achieve healthy weight goals. First-line therapy is metformin at 1000-2000 mg/d. Goals include a fasting glucose level goal of less than 126 mg/dL and/or an HbA1c level of less than 7%. […] If goals in step 1 not achieved after 3 months (fasting glucose level 126 mg/dL or HbA1c level 7%), add 0.4-0.6 U/kg of 24-hour insulin at bedtime (Glargine or Levemir). If combination therapy is inadequate after 3 months, intensify insulin therapy until the fasting plasma glucose level is less than 126 mg/dL and the HbA1c level is less than 7%.

• #37 Type 2 diabetes in children – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/786

  Dapagliflozin approved by FDA for treatment of type 2 diabetes in children. The sodium-glucose cotransporter-2 (SGLT2) inhibitor dapagliflozin has been approved by the US Food and Drug Administration (US FDA) to improve glycaemic control in paediatric patients with type 2 diabetes aged 10 years and older. […] Dapagliflozin has also received approval from the European Medicines Agency (EMA) for use in children aged 10 years with uncontrolled type 2 diabetes as an adjunct to diet and exercise. […] Goals of treatment are to promote weight loss and exercise capacity, normalise glycaemia and haemoglobin A1c (goal is 48 mmol/mol [6.5%], and prevent long-term complications and comorbidities (e.g., retinopathy, hypertension, and dyslipidaemia). Initial treatment includes lifestyle modifications, metformin, and insulin. Glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT2) inhibitors are approved in some countries as an additional non-insulin treatment option for children aged 10 years.

• #38 FDA Approves New Class of Medicines to Treat Pediatric Type 2 Diabetes | FDA

  https://www.fda.gov/news-events/press-announcements/fda-approves-new-class-medicines-treat-pediatric-type-2-diabetes

  Today, the U.S. Food and Drug Administration approved Jardiance (empagliflozin) and Synjardy (empagliflozin and metformin hydrochloride) as additions to diet and exercise to improve blood sugar control in children 10 years and older with type 2 diabetes. […] These approvals provide a new class of medicines taken by mouth to treat pediatric type 2 diabetes. […] Todays approvals provide much-needed additional treatment options for children with type 2 diabetes. […] The safety and efficacy of empagliflozin in children were studied in a double-blind, randomized, placebo-controlled trial in 157 patients aged 10 to 17 years with inadequately controlled type 2 diabetes. […] The trial found that, at week 26, treatment with empagliflozin was superior in reducing hemoglobin A1c, a measure of average blood sugar, compared to placebo.

• #39 FDA Approves New Class of Medicines to Treat Pediatric Type 2 Diabetes | FDA

  https://www.fda.gov/news-events/press-announcements/fda-approves-new-class-medicines-treat-pediatric-type-2-diabetes

  Patients treated with empagliflozin also had reductions in fasting plasma glucose, a blood sugar measurement taken after not eating or drinking for at least eight hours, as compared to patients taking placebo. […] Common side effects in children treated with empagliflozin were generally similar to those reported in adults, except there was a higher risk of hypoglycemia (low blood sugar) among pediatric patients 10 years and older taking empagliflozin compared to placebo, regardless of whether they were taking other therapies for diabetes.

• #40 Pediatric Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Proposed Management Algorithm

  https://emedicine.medscape.com/article/925700-treatment

  Ideally, management of diabetes should involve a pediatric endocrinologist, a diabetes nurse educator, a nutritionist, and a behavioral specialist. […] The American Academy of Pediatrics (AAP) issued clinical practice guidelines on the management of type 2 diabetes in children and adolescents. The guidelines recommend insulin treatment in all patients who present with ketosis or extremely high blood glucose levels because it may not be clear initially whether these patients have type 2 or type 1 diabetes. Once a diagnosis of type 2 diabetes is confirmed, lifestyle modification and metformin treatment should be initiated. […] The goal of therapy is to achieve and maintain euglycemia, as well as near-normal hemoglobin A1c (HbA1c) levels (7%). Patients who are not ill at diagnosis can be treated initially with lifestyle changes (eg, diet, exercise, weight control). However, because few patients can maintain euglycemia with lifestyle changes alone, most children and adolescents require medication.

• #41 Pediatric Type 2 Diabetes Mellitus Treatment & Management: Approach Considerations, Pharmacologic Therapy, Proposed Management Algorithm

  https://emedicine.medscape.com/article/925700-treatment

  Canagliflozin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor, was approved by the FDA for use in pediatric patients aged 10 years and older with type 2 diabetes mellitus in December 2024. […] Diabetes education is indicated, including lifestyle changes to achieve healthy weight goals. First-line therapy is metformin at 1000-2000 mg/d. Goals include a fasting glucose level goal of less than 126 mg/dL and/or an HbA1c level of less than 7%. […] If goals in step 1 not achieved after 3 months (fasting glucose level 126 mg/dL or HbA1c level 7%), add 0.4-0.6 U/kg of 24-hour insulin at bedtime (Glargine or Levemir). If combination therapy is inadequate after 3 months, intensify insulin therapy until the fasting plasma glucose level is less than 126 mg/dL and the HbA1c level is less than 7%.

• #42

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10288292/

  The first choice of antihyperglycemic drugs in the initial treatment of children and adolescents with type 2 diabetes includes metformin and/or insulin alone or in combination, as determined by clinical symptoms, severity of hyperglycemia, and the presence or absence of ketosis/diabetic ketoacidosis. […] For patients with stable glycemia, defined as an HbA1c level of less than 8.5% (69 mmol/mol), metformin should be used at a maximum dose of 2 g/d together with a healthy lifestyle intervention. […] The goal of the initial treatment was to achieve an HbA1c level of less than 7.0% (53 mmol/mol). […] If the HbA1c target is not achieved and the HbA1c level is 6.5-9.0% (48-74 mmol/mol), metformin monotherapy should be continued with a maximum dose of 2 g/d within 4 mo, in addition to a second drug.

• #43 Treating Type 2 Diabetes in Children – Learning About Diabetes | Diabetes Self-Management

  https://www.diabetesselfmanagement.com/about-diabetes/diabetes-kids/treating-type-2-diabetes-in-children/

  Regular blood glucose monitoring is important to evaluate the effectiveness of a child’s diabetes treatment regimen. […] Another important blood test for every person with diabetes is the glycosylated hemoglobin (HbA1c) test, which gives an indication of longer-term blood glucose control. […] If your child has high blood pressure along with Type 2 diabetes, it is important to treat his blood pressure through dietary changes, exercise, and possibly through medicines. […] Some children with Type 2 diabetes also have high blood lipid levels. […] Also important are regular visits to your physician and other members of your child’s diabetes team for routine health exams. […] When it comes to making lifestyle changes, it’s often helpful to have the entire family involved in making those changes together.

• #44 Type 2 diabetes in children – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/type-2-diabetes-in-children/diagnosis-treatment/drc-20355324

  Everyone needs regular aerobic exercise, and children who have type 2 diabetes are no exception. […] There are three medications that have been approved by the Food and Drug Administration (FDA) for treating type 2 diabetes in children. […] Sometimes, insulin may be needed if your child’s blood sugar levels are very high. […] Your health care provider will let you know how often you or your child need to check and record your child’s blood sugar. […] These procedures are not an option for everyone. But for teens who are significantly obese a body mass index (BMI) at or above 35 having weight-loss surgery may lead to improved management of type 2 diabetes. […] Your child will need regular appointments to ensure good diabetes management. […] Healthy-lifestyle changes can reduce the need for medications. […] Your health care provider may check your child’s A1C levels. […] If you suspect hyperglycemia, check your child’s blood sugar. […] Living with type 2 diabetes isn’t easy for you or for your child. Good diabetes management requires a lot of changes, especially in the beginning.

• #45 Treating Type 2 Diabetes – Kidshealth | Akron Children’s

  https://www.akronchildrens.org/kidshealth/en/parents/treating-type2.html

  Daily, you and your child will check glucose levels. Kids and teens do this using a blood glucose meter or a continuous glucose monitor (CGM). If your child uses a blood glucose meter and is on insulin, theyll check their blood sugar about four times each day. If they wear a CGM, it will automatically measure sugar levels day and night.

• #46 Treating Type 2 Diabetes in Children – Learning About Diabetes | Diabetes Self-Management

  https://www.diabetesselfmanagement.com/about-diabetes/diabetes-kids/treating-type-2-diabetes-in-children/

  Regular blood glucose monitoring is important to evaluate the effectiveness of a child’s diabetes treatment regimen. […] Another important blood test for every person with diabetes is the glycosylated hemoglobin (HbA1c) test, which gives an indication of longer-term blood glucose control. […] If your child has high blood pressure along with Type 2 diabetes, it is important to treat his blood pressure through dietary changes, exercise, and possibly through medicines. […] Some children with Type 2 diabetes also have high blood lipid levels. […] Also important are regular visits to your physician and other members of your child’s diabetes team for routine health exams. […] When it comes to making lifestyle changes, it’s often helpful to have the entire family involved in making those changes together.

• #47 Type 2 Diabetes Mellitus in Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1101/p590.html

  Management of type 2 diabetes should be focused on a multidisciplinary, family-centered, culturally appropriate approach. […] Clinicians should focus on nutritional counseling for children with type 2 diabetes at the time of diagnosis and as a part of ongoing management. […] Exercise counseling should also be addressed at the time type 2 diabetes is diagnosed and as a part of ongoing management. […] Metformin and insulin are the only medications for type 2 diabetes that are approved by the U.S. Food and Drug Administration for use in children and adolescents. […] Although newly diagnosed type 2 diabetes may respond to metformin and lifestyle changes, insulin therapy must be initiated if the patient has signs of ketosis or ketoacidosis. […] The American Academy of Pediatrics recommends that clinicians monitor A1C levels every three months in children and adolescents with type 2 diabetes.

• #48 Type 2 Diabetes in Children and Adolescents – Diabetes Canada

  https://www.diabetes.ca/health-care-providers/clinical-practice-guidelines/chapter-35

  Insulin is required in those with severe metabolic decompensation at diagnosis (e.g. DKA, A1C 9.0%, symptoms of severe hyperglycemia) but may be successfully weaned once glycemic targets are achieved. […] Metformin should generally be started at the same time as insulin unless acidosis is present. […] Children with type 2 diabetes should receive ongoing intensive counselling, including healthy behaviour interventions, from an interprofessional pediatric health-care team that includes either a pediatric endocrinologist or pediatrician with diabetes expertise, diabetes educator and mental health professional. […] The target A1C for most children with type 2 diabetes should be 7.0%. […] In children with type 2 diabetes and A1C 9.0% and in those with severe metabolic decompensation (e.g. DKA), insulin therapy should be initiated but may be successfully weaned once glycemic targets are achieved.

• #49 Type 2 diabetes in children – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/786

  Dapagliflozin approved by FDA for treatment of type 2 diabetes in children. The sodium-glucose cotransporter-2 (SGLT2) inhibitor dapagliflozin has been approved by the US Food and Drug Administration (US FDA) to improve glycaemic control in paediatric patients with type 2 diabetes aged 10 years and older. […] Dapagliflozin has also received approval from the European Medicines Agency (EMA) for use in children aged 10 years with uncontrolled type 2 diabetes as an adjunct to diet and exercise. […] Goals of treatment are to promote weight loss and exercise capacity, normalise glycaemia and haemoglobin A1c (goal is 48 mmol/mol [6.5%], and prevent long-term complications and comorbidities (e.g., retinopathy, hypertension, and dyslipidaemia). Initial treatment includes lifestyle modifications, metformin, and insulin. Glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT2) inhibitors are approved in some countries as an additional non-insulin treatment option for children aged 10 years.

• #50 Type 2 diabetes in children – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/type-2-diabetes-in-children/diagnosis-treatment/drc-20355324

  Everyone needs regular aerobic exercise, and children who have type 2 diabetes are no exception. […] There are three medications that have been approved by the Food and Drug Administration (FDA) for treating type 2 diabetes in children. […] Sometimes, insulin may be needed if your child’s blood sugar levels are very high. […] Your health care provider will let you know how often you or your child need to check and record your child’s blood sugar. […] These procedures are not an option for everyone. But for teens who are significantly obese a body mass index (BMI) at or above 35 having weight-loss surgery may lead to improved management of type 2 diabetes. […] Your child will need regular appointments to ensure good diabetes management. […] Healthy-lifestyle changes can reduce the need for medications. […] Your health care provider may check your child’s A1C levels. […] If you suspect hyperglycemia, check your child’s blood sugar. […] Living with type 2 diabetes isn’t easy for you or for your child. Good diabetes management requires a lot of changes, especially in the beginning.

• #51 Treatment options and current guidelines of care for pediatric type 2 diabetes patients: a narrative review

  https://www.degruyter.com/document/doi/10.1515/jom-2020-0172/html?lang=en

  According to ADA guidelines, newly diagnosed children with T2D and their families should be counseled on lifestyle interventions and given diabetes education. […] Metformin therapy has been used as a comparison therapy in previous trials, including TODAY and RISE. […] Initial treatment for symptomatic pediatric patients with an HbA1c greater than or equal to 8.5% or with blood glucose greater than or equal to 250 mg/dL should include metformin and basal insulin. […] According to ADA guidelines, patients presenting with ketosis or diabetic ketoacidosis should be treated with subcutaneous or IV insulin immediately. […] ADA guidelines support metabolic surgery as a treatment option in some adolescent patients with T2D.

• #52 A practical evidence-based approach to management of type 2 diabetes in children and young people (CYP): UK consensus | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03349-4

  We recommend that self-monitoring of blood glucose is undertaken in all patients in line with other international guidelines. […] We recommend that CYP should be managed by multi-disciplinary secondary care teams with close integration with primary care and collaboration with adult diabetes teams. […] Lifestyle change is the cornerstone of type 2 diabetes management. […] Metformin should be started once any ketosis has resolved, starting at a low dose to minimise side-effects and titrated to a maximum of 2 g per day, or the maximum tolerated dose. […] Failure to achieve goal HbA1c with metformin monotherapy should prompt consideration of second-line treatment with liraglutide. […] Bariatric surgery in adolescents leads to successful weight loss in those with severe obesity (BMI35 kg/m2) and demonstrates greater weight loss outcomes when compared with lifestyle and liraglutide.

• #53 Surgical or Medical Treatment for Pediatric Type 2 Diabetes | Shah Lab

  https://www.cincinnatichildrens.org/research/divisions/e/endocrinology/labs/shah/surgical-medical-treatment-pediatric-type-2-diabetes

  Bariatric surgery in teens has beneficial effects on weight loss. Initial studies show bariatric surgery may also help improve blood glucose control in teens with type 2 diabetes. We are studying the effects of bariatric surgery on blood glucose control and diabetes related health outcomes. We are comparing surgery to newer type 2 diabetes medications to see if the same outcomes can be achieved with medications and lifestyle modification. […] Effect of Surgical versus Medical Therapy on Diabetic Kidney Disease in Severely Obese Adolescents with Type 2 Diabetes.

• #54 Children and type 2 diabetes | Guide to diabetes | Diabetes UK

  https://www.diabetes.org.uk/living-with-diabetes/life-with-diabetes/children-and-diabetes/type-2

  Type 2 diabetes in children and young adults is known to be a more aggressive form of the condition. If it’s left untreated, type 2 diabetes can lead to permanent damage in the body due to the build-up of sugar in the blood – but it can be managed well. With the right specialist support, it’s possible to live well and avoid complications. […] If your child is diagnosed with type 2 diabetes, the usual treatment is metformin, and insulin is also commonly used. Some children over ten years might also have different types of medication prescribed called GLP-1 agonists or SGLT-2 inhibitors if they meet certain criteria. […] There is evidence to suggest that children with type 2 diabetes who receive care from specialist paediatric diabetes clinics get better support to manage their diabetes.

• #55 Type 2 Diabetes in Children and Adolescents – Diabetes Canada

  https://www.diabetes.ca/health-care-providers/clinical-practice-guidelines/chapter-35

  If glycemic targets are not achieved within 36 months from diagnosis, then basal insulin should be initiated. […] If targets are still not achieved on a combination of metformin and basal insulin, then prandial insulin should be initiated. […] Children with type 2 diabetes should be screened for neuropathy at diagnosis and annually thereafter. […] Children with type 2 diabetes should be screened at diagnosis for retinopathy and yearly thereafter. […] Children with type 2 diabetes should be screened for chronic kidney disease at diagnosis and yearly thereafter. […] Children with type 2 diabetes with persistent albuminuria should be referred to a pediatric nephrologist for assessment of etiology and treatment.

• #56 Type 2 diabetes in children – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/type-2-diabetes-in-children/symptoms-causes/syc-20355318

  Type 2 diabetes in children is a chronic disease that affects the way your child’s body processes sugar (glucose) for fuel. Without treatment, the disorder causes sugar to build up in the bloodstream, which can lead to serious long-term consequences. […] There’s plenty you can do to help manage or prevent type 2 diabetes in your child. Encourage your child to eat healthy foods, get plenty of physical activity and maintain a healthy weight. If healthy eating and exercise aren’t enough to control type 2 diabetes, oral medication or insulin treatment may be needed. […] Keeping your child’s blood sugar level close to the standard range most of the time can dramatically reduce the risk of these complications. You can help your child prevent diabetes complications by: […] Working with your child to maintain good blood sugar control as much as possible

• #57 Type 2 Diabetes in Children and Adolescents – Diabetes Canada

  https://www.diabetes.ca/health-care-providers/clinical-practice-guidelines/chapter-35

  If glycemic targets are not achieved within 36 months from diagnosis, then basal insulin should be initiated. […] If targets are still not achieved on a combination of metformin and basal insulin, then prandial insulin should be initiated. […] Children with type 2 diabetes should be screened for neuropathy at diagnosis and annually thereafter. […] Children with type 2 diabetes should be screened at diagnosis for retinopathy and yearly thereafter. […] Children with type 2 diabetes should be screened for chronic kidney disease at diagnosis and yearly thereafter. […] Children with type 2 diabetes with persistent albuminuria should be referred to a pediatric nephrologist for assessment of etiology and treatment.

• #58 Type 2 Diabetes in Children and Adolescents – Diabetes Canada

  https://www.diabetes.ca/health-care-providers/clinical-practice-guidelines/chapter-35

  If glycemic targets are not achieved within 36 months from diagnosis, then basal insulin should be initiated. […] If targets are still not achieved on a combination of metformin and basal insulin, then prandial insulin should be initiated. […] Children with type 2 diabetes should be screened for neuropathy at diagnosis and annually thereafter. […] Children with type 2 diabetes should be screened at diagnosis for retinopathy and yearly thereafter. […] Children with type 2 diabetes should be screened for chronic kidney disease at diagnosis and yearly thereafter. […] Children with type 2 diabetes with persistent albuminuria should be referred to a pediatric nephrologist for assessment of etiology and treatment.

• #59 Type 2 diabetes in children – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/type-2-diabetes-in-children/diagnosis-treatment/drc-20355324

  Everyone needs regular aerobic exercise, and children who have type 2 diabetes are no exception. […] There are three medications that have been approved by the Food and Drug Administration (FDA) for treating type 2 diabetes in children. […] Sometimes, insulin may be needed if your child’s blood sugar levels are very high. […] Your health care provider will let you know how often you or your child need to check and record your child’s blood sugar. […] These procedures are not an option for everyone. But for teens who are significantly obese a body mass index (BMI) at or above 35 having weight-loss surgery may lead to improved management of type 2 diabetes. […] Your child will need regular appointments to ensure good diabetes management. […] Healthy-lifestyle changes can reduce the need for medications. […] Your health care provider may check your child’s A1C levels. […] If you suspect hyperglycemia, check your child’s blood sugar. […] Living with type 2 diabetes isn’t easy for you or for your child. Good diabetes management requires a lot of changes, especially in the beginning.

• #60 Pediatric Type 2 Diabetes Treatment : Types and How To Get Help?

  https://diabetesmantra.com/diabetes/treatment/pediatric-type-2-diabetes-treatment/

  Managing pediatric type 2 diabetes goes beyond physical health; it also involves addressing the emotional and psychological aspects. […] Preventive measures play a crucial role in the effective treatment of pediatric type 2 diabetes. These measures involve family education, early intervention, and community engagement to create an environment that supports healthier lifestyles. […] Empowering parents with knowledge and tools to create a health-conscious environment at home is essential. […] Educating families about the importance of a balanced diet, regular physical activity, and early recognition of risk factors contributes to preventing the onset of pediatric type 2 diabetes. […] By prioritizing the well-being of our younger generation through a comprehensive treatment plan, we can pave the way for healthier futures and a reduction in the prevalence of this chronic condition.

• #61 Management of type 2 diabetes mellitus in children and adolescents – UpToDate

  https://www.uptodate.com/contents/management-of-type-2-diabetes-mellitus-in-children-and-adolescents

  Management of type 2 diabetes mellitus in children and adolescents […] The largest clinical trial, Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY study), has shown that oral agent monotherapy does not maintain durable glycemic control in a majority of patients with adolescent-onset T2DM. […] It is important to optimize treatment using a combination of pharmacologic and nonpharmacologic interventions, with close monitoring and follow-up. […] Ideally, the care of an adolescent with T2DM should be managed by a multidisciplinary team, including an endocrinologist, nurse educator, dietitian, mental health professional, and sometimes an exercise physiologist. […] Patients who do not achieve good glycemic control on metformin monotherapy should be managed by or in consultation with an endocrinologist and diabetes educator, if at all possible. […] Family involvement is essential to initiate and support the lifestyle changes required in the management of a pediatric patient with this disorder. […] The management of T2DM in children and adolescents is presented here.

• #62 Treating Type 2 Diabetes in Children – Learning About Diabetes | Diabetes Self-Management

  https://www.diabetesselfmanagement.com/about-diabetes/diabetes-kids/treating-type-2-diabetes-in-children/

  Eating a more healthful diet and becoming more aware of the amounts of carbohydrate, fat, and protein one eats often contributes to weight loss for a person who is overweight. […] Getting more physical activity can also lead to improved fitness levels and weight loss, but more important, it can be fun if it is approached with a positive attitude. […] You are not alone in the treatment of your child with Type 2 diabetes.

• #63 Management of Type 2 Diabetes in Youth: An Update | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0901/p658.html

  Youths should self-manage their diabetes to the extent that is appropriate for their age and maturity level. […] Adolescents usually have the motor and cognitive skills to perform all diabetes-related tasks, including determining insulin doses based on blood glucose levels and food intake. […] Accommodations may be needed to manage diabetes at school (e.g., in the classroom, during physical education, field trips, and after-school activities).

• #64 Management of Type 2 Diabetes in Youth: An Update | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0901/p658.html

  Youths should self-manage their diabetes to the extent that is appropriate for their age and maturity level. […] Adolescents usually have the motor and cognitive skills to perform all diabetes-related tasks, including determining insulin doses based on blood glucose levels and food intake. […] Accommodations may be needed to manage diabetes at school (e.g., in the classroom, during physical education, field trips, and after-school activities).

• #65 Diabetes – issues for children and teenagers | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/diabetes-issues-for-children-and-teenagers

  People living with type 1 diabetes must inject insulin multiple times a day, as must some people with type 2 diabetes. Many people with type 2 diabetes can manage their condition with healthy food choices, exercise, medication and regular glucose monitoring. […] Children with diabetes will need help from parents and loved ones to establish a routine to manage their diabetes. This includes: blood glucose monitoring, injecting insulin, learning how to count carbohydrates, seeing diabetes health professionals regularly, cope with fluctuating blood glucose levels. […] With support and guidance, your child can learn to incorporate diabetes care into their everyday life and develop lifelong skills and confidence. […] Diabetes Camps Victoria runs camps especially for children and adolescents aged between 4 and 17 years who have been diagnosed with type 1 diabetes. The goal of the program is to teach young people to manage their diabetes in a fun, safe and supportive environment, and to promote a culture of independence through adventure. […] If you think your child has an eating disorder or is overly concerned about their body image and weight, talk to their diabetes treating team or dietitian about appropriate counselling and support.

• #66 Type 2 Diabetes: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21501-type-2-diabetes

  Type 2 diabetes is very common. More than 37 million people in the U.S. have diabetes (about 1 in 10 people), and about 90% to 95% of them have T2D. […] T2D most commonly affects adults over 45, but people younger than 45 can have it as well, including children. […] The core features of Type 2 diabetes management include: Lifestyle changes, like more exercise and eating adjustments. Blood sugar monitoring. Medication. […] Regular activity is important for everyone. Its even more important if you have diabetes. […] Ask your healthcare provider or registered dietitian to recommend a meal plan thats right for you. […] Your healthcare provider may recommend taking medication, in addition to lifestyle changes, to manage Type 2 diabetes. […] Type 2 diabetes is a chronic (long-term) disease, which means you must manage it for the rest of your life.

• #67 Get Type 2 Diabetes Treatment | Cleveland Clinic Children’s

  https://my.clevelandclinic.org/pediatrics/services/type-2-diabetes-treatment

  Weight management is an important goal of type 2 diabetes treatment. A healthy diet, fun physical activity and medicines or bariatric surgery, are all treatment options. […] Our compassionate team keeps an eye on your childs emotional and social needs throughout their treatment. […] Type 2 diabetes can be a lifelong challenge. So when its time, well make it easy for your child to transition to adult diabetes care by gradually helping them get to know their adult providers, so they feel comfortable with the switch.

• #68 Treatment options and current guidelines of care for pediatric type 2 diabetes patients: a narrative review

  https://www.degruyter.com/document/doi/10.1515/jom-2020-0172/html?lang=en

  Type 2 diabetes (T2D) mellitus, which was once considered a disease affecting adults, is a growing problem among youths. […] There are very limited treatment options available to manage pediatric T2D. […] Prevention of pediatric T2D is paramount, which requires a high index of suspicion, routine screening of children and adolescents, and willingness to engage in family-based interventions for those at risk for prediabetes and T2D. […] Youth-onset T2D is more virulent and more progressive than adult-onset T2D, meaning that a gentle and progressive-intensity approach is less likely to be successful. Instead, treatment should start immediately upon diagnosis. […] The ADA recommends initiating comprehensive lifestyle programs and diabetes education for families, with a goal of 7-10% decrease in body weight.

• #69 Type 2 Diabetes: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21501-type-2-diabetes

  Certain strategies can help lower your risk of developing Type 2 diabetes or delay its onset, including: Exercising regularly (at least 150 minutes a week). Maintaining a weight thats healthy for you. Eating nutritious food. Not smoking. […] Type 2 diabetes can affect your life in many ways. At Cleveland Clinic, we can help develop a treatment plan that matches you and your goals.

• #70 Management of Type 2 Diabetes in Youth: An Update | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/0901/p658.html

  Although type 1 diabetes historically has been more common in patients eight to 19 years of age, type 2 diabetes is emerging as an important disease in this group. Type 2 diabetes accounts for 8 to 45 percent of new childhood diabetes. This article is an update from the National Diabetes Education Program on the management of type 2 diabetes in youth. […] Reducing overweight and impaired glucose tolerance with increased physical activity and healthier eating habits may help prevent or delay the development of type 2 diabetes in high-risk youths. […] Patients diagnosed with diabetes should receive self-management education, behavior interventions to promote healthy eating and physical activity, appropriate therapy for hyperglycemia (usually metformin and insulin), and treatment of comorbidities.

• #71 Type 2 diabetes in children: Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/322919

  The treatment for type 2 diabetes is usually similar in children and adults, including diet, lifestyle, and exercise recommendations, though the FDA have approved fewer drugs for children. […] A child with type 2 diabetes may need to monitor their blood glucose level regularly. […] Daily lifestyle choices are extremely important for children with diabetes. These include weight management, regular physical activity, and dietary changes. […] A doctor may also prescribe other medications that help the body respond better to insulin. […] The doctor will individualize the treatment and diet plan according to the child’s age and needs and the severity of the condition.

• #72 What Is Type 2 Diabetes? (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/type2.html

  Kids and teens with type 2 diabetes often go to a pediatric endocrinologist for treatment. This kind of doctor treats problems affecting hormones, like diabetes. They also may see a dietitian, diabetes educator, or weight management specialist. […] The goal of treatment for type 2 diabetes is to keep blood sugar levels in a healthy range. Treatment usually includes: eating a healthy, balanced diet, getting regular physical activity, checking blood sugar levels regularly, losing weight, if recommended, taking anti-diabetes pills or getting insulin (by injection or with a pump). If blood sugars remain high, the doctor may add another medicine.

• #73 Diagnosis, treatment and prevention of type 2 diabetes mellitus in children and adolescents

  https://www.wjgnet.com/1948-9358/full/v12/i4/344.htm

  During the last two decades, there have been several reports of an increasing incidence of type 2 diabetes mellitus (T2DM) in children and adolescents, especially among those belonging to minority ethnic groups. […] Current management approaches include lifestyle changes, such as improved diet and increased physical activity, together with pharmacological interventions, including metformin, insulin, and the recently approved glucagon-like peptide-1 analog liraglutide. […] T2DM management is based upon the combined application of lifestyle interventions and pharmacological treatments. […] The best approach to manage adolescents with T2DM is a combination of non-pharmacologic and pharmacologic interventions, with close monitoring and follow-up. […] The goals of managing an adolescent with T2DM are the following: (1) To achieve and maintain near-normal glycemic levels with minimal hypoglycemic episodes; (2) To improve body weight, insulin sensitivity and possibly insulin secretion, in order to achieve better glycemic control and improved overall health; (3) To identify and manage the disease in a timely manner and, if necessary, comorbidities and complications such as hypertension, dyslipidemia, hepatic steatosis, nephropathy, and retinopathy; and (4) To prevent or delay, as much as possible, macrovascular complications of T2DM, such as cardiovascular disease and stroke.

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