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First-Ever Guidelines for Children With Diabetes

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By Miriam E. Tucker
Medscape Medical News

Jan. 29, 2013 -- The American Academy of Pediatrics has issued the first-ever guidelines for the management of type 2 diabetes in children and teens.

Type 2 diabetes is rising rapidly among children and teens because of soaring obesity rates. It now accounts for up to 1 in 3 new cases of diabetes in those younger than 18. These guidelines are for children between the ages of 10 and 18.

"Few providers have been trained in managing type 2 diabetes in children and, to date, few medications have been evaluated for safety and [effectiveness] in children," says co-author Janet Silverstein, MD, professor of pediatrics at the University of Florida and chief of endocrinology at Shands Hospital in Gainesville.

"This is a real issue in the pediatric population. It's something that many of us as pediatricians didn't grow up with because we just didn't see it very often," she says.

Recommendations

Central to the recommendations is the proper diagnosis of either type 1 or type 2 diabetes. But this can often take time and is not always clear-cut.

Because of that, the guidelines recommend giving insulin to patients if it's not clear whether they have type 1 or type 2 diabetes. If type 2 diabetes is confirmed, lifestyle changes along with the medication metformin are recommended. Metformin and insulin are the only two blood sugar-lowering medications approved for those younger than 18, but others are being studied, Silverstein says. 

The panel also recommended that children with type 2 diabetes get their hemoglobin A1c levels measured every three months. The test measures blood sugar levels for the past two or three months.

The panel that wrote the guidelines endorsed an A1c goal of less than 7% for young people with type 2 diabetes, but noted it may be adjusted depending on the person.

Finger-stick self-glucose monitoring is advised for all patients taking insulin or another class of diabetes medication called sulfonylureas, along with those starting or changing therapy and those who haven't met treatment goals.

Recommendations on frequency of monitoring vary, but generally the panel endorsed the ADA's guidelines, which include three or more times daily for those on insulin and less frequent measurement, including after-meal checks, for those not on insulin.

The panel also recommended nutrition counseling, moderate to vigorous exercise for at least 60 minutes daily, and limiting screen time at home to less than two hours per day.

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People who experience hypoglycemia several times in a week should call their health care provider. It's important to monitor your levels each day so you can make sure your numbers are within the range. If you are pregnant always consult with your health care provider.

Congratulations on taking steps to manage your health.

However, it's important to continue to track your numbers so that you can make lifestyle changes if needed. If you are pregnant always consult with your physician.

Your level is high if this reading was taken before eating. Aim for 70-130 before meals and less than 180 two hours after meals.

Even if your number is high, it's not too late for you to take control of your health and lower your blood sugar.

One of the first steps is to monitor your levels each day. If you are pregnant always consult with your physician.

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