Last updated March 15, 2022

Management of Newly Diagnosed Type 2 Diabetes Mellitus (T2DM) in Children and Adolescents

Key action statements

1. Clinicians must ensure that insulin therapy is initiated for children and adolescents with T2DM who are ketotic or in diabetic ketoacidosis and in whom the distinction between types 1 and 2 diabetes mellitus is unclear and, in usual cases, should initiate insulin therapy for patients
  1. who have random venous or plasma BG concentrations ≥250 mg/dL; or
  2. whose HbA1c is 9%.
(E, Weak)
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2. In all other instances, clinicians should initiate a lifestyle modification program, including nutrition and physical activity, and start metformin as first-line therapy for children and adolescents at the time of diagnosis of T2DM. (B, Strong)
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3. The committee suggests that clinicians monitor HbA1c concentrations every 3 months and intensify treatment if treatment goals for finger-stick BG and HbA1c concentrations are not being met (intensification is defined in the Definitions box). (D, Weak)
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4. The committee suggests that clinicians advise patients to monitor finger-stick BG concentrations in patients who
  1. are taking insulin or other medications with a risk of hypoglycemia; or
  2. are initiating or changing their diabetes treatment regimen; or
  3. have not met treatment goals; or
  4. have intercurrent illnesses.
(D, Weak)
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5. The committee suggests that clinicians incorporate the Academy of Nutrition and Dietetics’ Pediatric Weight Management Evidence-Based Nutrition Practice Guidelines in their dietary or nutrition counseling of patients with T2DM at the time of diagnosis and as part of ongoing management. (D, Weak)
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6. The committee suggests that clinicians encourage children and adolescents with T2DM to engage in moderate-to-vigorous exercise for at least 60 minutes daily and to limit nonacademic “screen time” to less than 2 hours a day. (D, Weak)
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Recommendation Grading

Overview

Title

Management of Newly Diagnosed Type 2 Diabetes Mellitus (T2DM) in Children and Adolescents

Authoring Organization

Publication Month/Year

February 1, 2013

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Child

Health Care Settings

Ambulatory, Emergency care, Home health, Outpatient

Intended Users

Dietician nutritionist, nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Prevention, Management, Treatment

Diseases/Conditions (MeSH)

D009765 - Obesity, D003920 - Diabetes Mellitus

Keywords

obesity, diabetes, exercise, type 2 diabetes mellitus, insulin, childhood obesity, family-centered approach, T2DM, childhood, youth

Source Citation

Kenneth C. Copeland, et. al. Management of Newly Diagnosed Type 2 Diabetes Mellitus (T2DM) in Children and Adolescents. 2013; 131(2): 364-382.