The incidence of type 2 diabetes (T2D) in people under the age of 20 is increasing in the United States, with one national study indicating a 4.8 percent increase of newly diagnosed cases of T2D in the age group from 2002 to 2012. Youth and adolescents living with T2D face many of the same challenges as adults diagnosed with the disease yet are at risk of developing diabetes-related complications at an earlier age, which can greatly impact their quality of life and life expectancy.
To address the specific needs of youth with T2D, the American Diabetes Association issued “Evaluation and Management of Youth-Onset Type 2 Diabetes : A Position Statement by the American Diabetes Association” today, which is available online and will be published in the December 2018 print issue of Diabetes Care.
A team of six pediatric endocrinology and psychology authorities from leading institutions across the United States convened to develop the position statement, which is based on expert consensus, scientific research, and review of more than 260 bodies of literature in the field. The statement’s objective is to provide an improved and up-to-date understanding of T2D in youth. It outlines pathophysiology, diagnosis, and risk factors, as well as components of lifestyle management, pharmacologic approaches to glycemic management and associated comorbidities, complications, and transition from pediatric to adult care.
The guidelines discuss pathogenesis, risk assessment, diagnostic criteria and the importance of confirming diabetes type in youth. Highlighted are the modifiable and nonmodifiable risk factors for T2D in youth, including puberty-related physiologic insulin resistance in obese youth. The authors emphasize there are fundamental differences in insulin sensitivity and beta cell (β-cell) function between youth and adults with prediabetes and T2D, which could offer an explanation as to why some youth develop T2D decades earlier than adults. Recommendations include risk-based screening for youth who are overweight or obese based on body mass index (BMI) measurements, and who have additional risk factors for diabetes. Additionally, experts recommend that children and adolescents who are overweight and obese in whom a T2D diagnosis is being considered have a panel of pancreatic autoantibodies tested to exclude the possibility of autoimmune type 1 diabetes.
Lifestyle management of T2D in youth is addressed in the statement, including recommendations on patient education, weight management, exercise, nutrition, and psychosocial factors. Guidelines suggest youth with T2D and their families receive comprehensive diabetes self-management education and support that is speciﬁc to youth and culturally appropriate, and that providers use standardized and validated tools to assess diabetes distress and mental/ behavioral health in youth with T2D, referring them to specialty care when necessary.
Also outlined in the guidelines are pharmacologic approaches to glycemic management of T2D in youth, including an algorithm illustrating the specific management of new onset diabetes in overweight youth. The position statement further indicates that metabolic surgery may be considered for the treatment of adolescents with T2D who have a BMI over 35 Kg/m², uncontrolled glycemia and/or serious comorbidities despite lifestyle and pharmacologic intervention.
Additionally, the statement details potential diabetes-related complications and guidelines on screening, prevention and management for each. Transitioning patients properly from pediatric to adult care providers is addressed as well, as the authors indicate this is essential in providing appropriate care of youth with T2D.
“Research has indicated type 2 diabetes appears to be more aggressive in youth than in adults, with a faster rate of deterioration of β-cell function and poorer response to glucose-lowering medications,” said lead author Silva Arslanian, MD, Scientific Director and Principal Investigator of the Center for Pediatric Research in Obesity and Metabolism, UPMC Children’s Hospital of Pittsburgh, and the Richard L. Day Endowed Professor of Pediatrics at the University of Pittsburgh School of Medicine. “Furthermore, there is a higher risk for complications in people with earlier-onset type 2 diabetes, which is possibly related to prolonged lifetime exposure to hyperglycemia and other atherogenic risk factors, including insulin resistance, dyslipidemia, hypertension, and chronic inﬂammation. Thus, we must continue to make strides in recognizing the specific needs of youth and adolescents who are at-risk or diagnosed with type 2 diabetes.”
“Over the last 20 years, there has been a tremendous increase in knowledge of youth onset type 2 diabetes and the important differences that exist from diabetes presenting at an older age. It is critical that we have a continually evolving understanding of how this disease impacts youth and that we implement effective strategies to best manage type 2 diabetes when diagnosed at a young age,” said ADA’s Chief Scientific, Medical and Mission Officer William T. Cefalu, MD.
Any future updates to pediatric care will be published in the ADA’s annual Standards of Medical Care in Diabetes.
About Diabetes Care®
Diabetes Care, a monthly journal of the American Diabetes Association (ADA), is the highest-ranked, peer-reviewed journal in the field of diabetes treatment and prevention. Dedicated to increasing knowledge, stimulating research and promoting better health care for people with diabetes, the journal publishes original articles on human studies in clinical care, education and nutrition; epidemiology, health services and psychosocial research; emerging treatments and technologies; and pathophysiology and complications. Diabetes Care also publishes the ADA’s recommendations and statements, clinically relevant review articles, editorials and commentaries. Topics covered are of interest to clinically oriented physicians, researchers, epidemiologists, psychologists, diabetes educators and other health care professionals.