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HANNA XU, MD, Cook County Health and Hospitals System, Chicago, Illinois

MICHAEL C. VERRE, MD, Northwestern University Feinberg School of Medicine, Chicago, Illinois

Am Fam Physician. 2018 Nov 1;98(9):590-594.

  Patient information: See related handout on type 2 diabetes mellitus in children.

This clinical content conforms to AAFP criteria for continuing medical education (CME). See the CME Quiz questions.

Author disclosure: No relevant financial affiliations.

The prevalence of type 2 diabetes mellitus in children and adolescents has increased worldwide over the past three decades. This increase has coincided with the obesity epidemic, and minority groups are disproportionately affected. 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. Diagnostic criteria include a fasting blood glucose level of 126 mg per dL or greater, a two-hour plasma glucose level of 200 mg per dL or greater during an oral glucose tolerance test, an A1C level of 6.5% or more, or a random plasma glucose level of 200 mg per dL or greater plus symptoms of polyuria, polydipsia, or unintentional weight loss. 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 should be initiated if there are signs of ketosis or ketoacidosis, or if the patient has significant hyperglycemia (A1C greater than 9% or a random plasma glucose level of 250 mg per dL or greater).

Type 2 diabetes mellitus is characterized by hyperglycemia with insulin resistance and impaired insulin secretion. In contrast with type 1 diabetes, pancreatic beta cell dysfunction in type 2 diabetes is not mediated by an autoimmune process.

WHAT IS NEW ON THIS TOPIC

Type 2 diabetes accounts for one in three newly diagnosed cases of diabetes in U.S. children and adolescents.

Up to 32% of adolescents with type 2 diabetes have hypertension at the time of diagnosis.

The American Diabetes Association recommends that screening for type 2 diabetes begin at 10 years of age or the onset of puberty in children who are overweight and have two additional risk factors.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical the 1 last update 04 Jul 2020 recommendationClinical recommendationEvidence ratingdiabetes side effects in elderly youth statistics in usa (⭐️ blood sugar chart) | diabetes side effects in elderly e119how to diabetes side effects in elderly for References

Management of type 2 diabetes mellitus should be focused on a multidisciplinary, family-centered, culturally appropriate approach.

C

2

diabetes side effects in elderly characteristics (🔥 what to eat) | diabetes side effects in elderly ketones in urinehow to diabetes side effects in elderly for Nutritional and exercise counseling should be initiated when type 2 diabetes is diagnosed, then addressed as part of ongoing management.

C

2

diabetes side effects in elderly ketoacidosis (☑ icd 10) | diabetes side effects in elderly home remedies forhow to diabetes side effects in elderly for Metformin in combination with diet and exercise is first-line therapy in children and adolescents 10 years and older who have type 2 diabetes.

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2, 19

Insulin therapy must be initiated in children and adolescents with type 2 diabetes if they have signs of ketosis or ketoacidosis.

C

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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%.

C

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A1C levels should be checked every three months in children and adolescents with type 2 diabetes.

C

2

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C

6, 11, 22


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

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Clinical recommendationEvidence the 1 last update 04 Jul 2020 ratingEvidence ratingReferences

Management of type 2 diabetes mellitus should be focused on a multidisciplinary, family-centered, culturally appropriate approach.

C

2

Nutritional and exercise counseling should be initiated when type 2 diabetes is diagnosed, then addressed as part of ongoing management.

C

2

Metformin in combination with diet and exercise is first-line therapy in children and adolescents 10 years and older who have the 1 last update 04 Jul 2020 type 2 diabetes.Metformin in combination with diet and exercise is first-line therapy in children and adolescents 10 years and older who have type 2 diabetes.

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Insulin therapy must be initiated in children and adolescents with type 2 diabetes if they have signs of ketosis or ketoacidosis.

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2

Insulin therapy should be initiated in children and adolescents without signs of ketosis or ketoacidosis who have for 1 last update 04 Jul 2020 random plasma glucose levels of at least 250 mg per dL (13.9 mmol per L), or whose A1C level is greater than 9%.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%.

C

2, 21

A1C levels should be checked every three months in children and adolescents with type 2 diabetes.

C

2

Comorbidities such as hypertension, hyperlipidemia, nephropathy, and retinopathy should be assessed in children and adolescents with type 2 diabetes.

C

6, 11, 22


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

The incidence of type 2 diabetes in children and adolescents has increased worldwide over the past three decades.1 Type 2 diabetes accounts for one in three new cases of diabetes diagnosed in children and adolescents in the United States.2 This increase has coincided with the obesity epidemic, and minority groups are disproportionately affected at all ages.3,4 Some studies have shown that children of women with gestational diabetes are at greater risk of for 1 last update 04 Jul 2020 type 2 diabetes.5The incidence of type 2 diabetes in children and adolescents has increased worldwide over the past three decades.1 Type 2 diabetes accounts for one in three new cases of diabetes diagnosed in children and adolescents in the United States.2 This increase has coincided with the obesity epidemic, and minority groups are disproportionately affected at all ages.3,4 Some studies have shown that children of women with gestational diabetes are at greater risk of type 2 diabetes.5

Physicians and health care systems are ill-equipped to handle the challenges associated with type 2 diabetes in children. Most education materials designed for children address type 1 diabetes.2 This article reviews recommendations from a clinical practice guideline by the American Academy of Pediatrics.2 It also highlights the American Diabetes Association''s entire family is involved.2,16 Engaging family members also improves medication adherence.2 Because type 2 diabetes disproportionately affects minorities, clinicians should ensure that family-centered education is culturally appropriate.2 Children and adolescents should self-manage their diabetes to the extent appropriate for their age.17 The psychosocial effects of diabetes should be addressed to help children and adolescents cope with the disease.17

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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.18 Metformin in combination with diet and exercise is first-line therapy in children 10 years and older.2,19 Metformin should be initiated at a dosage of 500 mg per day, regardless of the patient''Connor EA, Williams SB, Beil TL, Lutz KW. Effectiveness of primary care interventions for weight management in children and adolescents: an updated, targeted systematic review for the USPSTF. Evidence synthesis no. 76. AHRQ publication no. 10-05144-EF-1. Rockville, Md.: Agency for Healthcare Research and Quality; 2010.

4. diabetes side effects in elderly video (🔴 education) | diabetes side effects in elderly usually appears after age 40how to diabetes side effects in elderly for Mayer-Davis EJ, Bell RA, Dabelea D, et al. The many faces of diabetes in American youth: type 1 and type 2 diabetes in five race and the 1 last update 04 Jul 2020 ethnic populations: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2009;32(suppl 2):S99–S101.Mayer-Davis EJ, Bell RA, Dabelea D, et al. The many faces of diabetes in American youth: type 1 and type 2 diabetes in five race and ethnic populations: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2009;32(suppl 2):S99–S101.

5. American Diabetes Association. Classification and diagnosis of diabetes: standards of medical care in diabetes-2018. Diabetes Care. 2018;41(suppl 1):S13–S27.

6. American Diabetes Association. Children and adolescents: standards of medical care in diabetes-2018. Diabetes Care. 2018;41(suppl 1):S126–S136.

the 1 last update 04 Jul 2020 7. 7. diabetes side effects in elderly youth statistics (🔥 rise) | diabetes side effects in elderly januviahow to diabetes side effects in elderly for Mayer-Davis EJ, Beyer J, Bell RA, et al.; SEARCH for Diabetes in Yourth Study Group. Diabetes in African American youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2009;32(suppl 2):S112–S122.

8. Dabelea D, Pihoker C, Talton JW, et al. Etiological approach to characterization of diabetes type: the SEARCH for Diabetes in the 1 last update 04 Jul 2020 Youth Study. Diabetes Care. 2011;34(7):1628–1633.8. Dabelea D, Pihoker C, Talton JW, et al. Etiological approach to characterization of diabetes type: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2011;34(7):1628–1633.

for 1 last update 04 Jul 2020 9. 9. Klingensmith GJ, Pyle L, Arslanian S, et al. The presence of GAD and IA-2 antibodies in youth with a type 2 diabetes phenotype: results from the TODAY study. Diabetes Care. 2010;33(9):1970–1975.

10. Pinhas-Hamiel O, Zeitler P. Acute and chronic complications of type 2 diabetes mellitus in children and adolescents. Lancet. 2007;369(9575):1823–1831.

11. Dileepan K, Feldt MM. Type 2 diabetes mellitus in children and adolescents. Pediatr Rev. 2013;34(12):541–548.

12. American Diabetes Association. Type 2 diabetes in children the 1 last update 04 Jul 2020 and adolescents. Diabetes Care. 2000;23(3):381–389.12. American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care. 2000;23(3):381–389.

13. Buse JB, Kaufman FR, Linder B, Hirst K, El Ghormli L, Willi S; HEALTHY Study Group. Diabetes screening with hemoglobin A(1c) versus fasting plasma glucose in a multiethnic middle-school cohort. Diabetes Care. 2013;36(2):429–435.

14. Academy of Nutrition and Dietetics. Pediatric weight management (PWM) guideline (2015) [login required]. https://www.andeal.org/topic.cfm?menu=5296&cat=563. Accessed March 15, 2018.

15. diabetes side effects in elderly new zealand statistics (👍 would be considered) | diabetes side effects in elderly occurs whenhow to diabetes side effects in elderly for Smart CE, Annan F, Bruno LP, Higgins LA, Acerini CL. ISPAD clinical practice consensus guidelines 2014. Nutritional management in children and adolescents the 1 last update 04 Jul 2020 with diabetes. Pediatr Diabetes. 2014;15(suppl 20):135–153.Smart CE, Annan F, Bruno LP, Higgins LA, Acerini CL. ISPAD clinical practice consensus guidelines 2014. Nutritional management in children and adolescents with diabetes. Pediatr Diabetes. 2014;15(suppl 20):135–153.

16. diabetes side effects in elderly quote (⭐️ case study) | diabetes side effects in elderly onset agehow to diabetes side effects in elderly for Venditti EM, Tan K, Chang N, et al.; TODAY Study Group. Barriers and strategies for oral medication adherence for 1 last update 04 Jul 2020 among children and adolescents with type 2 diabetes. Diabetes Res Clin Pract. 2018;139:24–31.Venditti EM, Tan K, Chang N, et al.; TODAY Study Group. Barriers and strategies for oral medication adherence among children and adolescents with type 2 diabetes. Diabetes Res Clin Pract. 2018;139:24–31.

diabetes side effects in elderly in skinny people (🔥 ketones) | diabetes side effects in elderly januviahow to diabetes side effects in elderly for the 1 last update 04 Jul 2020 17. 17. Peterson K, Silverstein J, Kaufman F, Warren-Boulton E. Management of type 2 diabetes in youth: an update. Am Fam Physician. 2007;76(5):658–664.

18. Nadeau KJ, Anderson BJ, Berg EG, et al. Youth-onset type 2 diabetes consensus report: current status, challenges, and priorities. Diabetes Care. 2016;39(9):1635–1642.

19. Garber AJ, Duncan TG, Goodman AM, Mills DJ, Rohlf JL. Efficacy of metformin in type II diabetes: results of a double-blind, placebo-controlled, dose-response trial. Am J Med. 1997;103(6):491–497.

diabetes side effects in elderly straight talk (☑ level) | diabetes side effects in elderly genehow to diabetes side effects in elderly for 20. Zeitler P, Epstein L, Grey M, et al.; TODAY Study Group. Treatment options for type 2 diabetes in adolescents and youth: a study of the comparative efficacy of metformin alone or in combination with rosiglitazone or lifestyle intervention in adolescents with type 2 diabetes. Pediatr Diabetes. 2007;8(2):74–87.

diabetes side effects in elderly diagnosis (🔴 young adults early death) | diabetes side effects in elderly prevalencehow to diabetes side effects in elderly for for 1 last update 04 Jul 2020 21. 21. Gungor N, Hannon T, Libman I, Bacha F, Arslanian S. Type 2 diabetes mellitus in youth: the complete picture to date. Pediatr Clin North Am. 2005;52(6):1579–1609.

22. Rodriguez BL, Dabelea D, Liese AD; et al.SEARCH Study Group. Prevalence the 1 last update 04 Jul 2020 and correlates of elevated blood pressure in youth with diabetes mellitus: the SEARCH for Diabetes in Youth Study. J Pediatr. 2010;157(2):245–251.e1.22. Rodriguez BL, Dabelea D, Liese AD; et al.SEARCH Study Group. Prevalence and correlates of elevated blood pressure in youth with diabetes mellitus: the SEARCH for Diabetes in Youth Study. J Pediatr. 2010;157(2):245–251.e1.

23. Donaghue KC, Wadwa RP, Dimeglio LA, et al. ISPAD clinical practice consensus guidelines 2014. Microvascular and macrovascular complications in children and adolescents. Pediatr Diabetes. 2014;15(suppl 20):257–269.

diabetes side effects in elderly yeast infection (☑ levels) | diabetes side effects in elderly coronavirus riskhow to diabetes side effects in elderly for 24. Rapaport R, Silverstein JH, Garzarella L, Rosenbloom AL. Type 1 and type 2 diabetes mellitus in childhood in the United States: practice patterns by pediatric endocrinologists. J Pediatr Endocrinol Metab. 2004;17(6):871–877.

25. Centers for Disease Control and Prevention. Pneumococcal disease: pneumococcal vaccination. September 6, 2017. https://www.cdc.gov/pneumococcal/vaccination.html. Accessed March 15, 2018.

 

 

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