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Diabetes Type II - Pediatrics

While once considered an adult pathology, it is increasingly prevalent in children. However, presentation and management differ from adults with the disorder. Children with diabetes of any kind are at an increased risk of many complications. Early recognition, screening, and treatment of children and adolescents with T2DM are important for preventing long-term complications from the disease.

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Obesity

Prolonged duration of abnormal weight gain

Family history and high-risk ethnic groups (black, hispanic, Native American, Asian American, Pacific Islander)

Sedentary lifestyle

Puberty

may attain a slightly shorter stature than their peers by adulthood, but may experience a growth spurt

Gestational Diabetes

studies have shown that female children who developed T2DM were below average weight during early childhood, yet experienced rapid weight gain beyond 4 and a half years of age.

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A growing global health concern, characterized by increasing prevalence and incidence, particularly among specific racial and ethnic groups, and strongly linked to childhood obesity. Reviews show higher rates in non-White youth, such as Black, Hispanic, and American Indian populations in the U.S. and globally, with significant regional variation. While often manageable with lifestyle changes and medication, youth-onset T2D presents unique challenges, including potential beta-cell decline and a need for tailored treatment approaches and consistent monitoring to prevent long-term complications and mortality.

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Involves insulin resistance and impaired beta-cell function, often driven by obesity, genetics, and environmental factors.

Unlike adult-onset T2DM, youth-onset T2DM is characterized by a more rapid and aggressive progression, leading to early complications like microvascular disease and macrovascular risk.

The development of T2DM is a complex gene-environment interaction with a high-calorie, sedentary lifestyle exacerbating genetic predispositions.

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Physical Activity: Aim for 60 minutes of moderate to vigorous activity daily, find activities the child enjoys, and incorporate active outings like biking or hiking.

Screen Time: Reduce screen time to less than two hours per day.

Diet: A balanced diet is recommended, focusing on reduced calorie intake (about 5-10% less than healthy peers), limiting sugary drinks and processed foods, and increasing fiber intake. Families are encouraged to read food labels and practice healthy eating.

Sedentary Behavior: Limiting screen time to less than two hours per day is an important goal to reduce sedentary habits.

Family Involvement: Including families in treatment planning is vital for education, adherence to lifestyle changes, and sustainable behavioral changes.

Behavioral support

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Metformin: A biguanide, it is the first-line oral drug for pediatric type 2 diabetes, reducing glucose production by the liver and improving insulin sensitivity.

Common Side Effects: Gastrointestinal issues like nausea, abdominal discomfort, and diarrhea, which often improve with gradual dose increases.

Dosage: Doses are typically started low (e.g., 500 mg once daily) and increased weekly to a target of 1000 mg twice daily to minimize GI side effects.

Empagliflozin and Combination Products: The FDA approved empagliflozin (e.g., Jardiance) and empagliflozin/metformin (e.g., Synjardy) for children 10 years and older, representing a new class of oral treatment.

Insulin: Can be necessary when oral medications are not enough to control blood sugar levels.

GLP-1 receptor agonists: Injections that can help with blood sugar control and weight management.

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Hosey, C. M., Halpin, K., Shakhnovich, V., Bi, C., Sweeney, B., Yan, Y., & Leeder, J. S. (2022). Pediatric growth patterns in youth‐onset type 2 diabetes mellitus: Implications for physiologically‐based pharmacokinetic models. CTS: Clinical & Translational Science, 15(4), 912–922. https://doi.org/10.1111/cts.13207

Ojo, O.A., Ibrahim, H.S., Rotimi, D.E., Ogunlakin, A.D., Ojo, A.B.,

Diabetes mellitus: From molecular mechanism to pathophysiology and pharmacology,

Medicine in Novel Technology and Devices,

Volume 19, 2023, 100247, ISSN 2590-0935,

https://doi.org/10.1016/j.medntd.2023.10024

Schmittdiel, J. A., Gopalan, A., Lin, M. W., Banerjee, S., Chau, C. V., & Adams, A. S. (2017). Population Health Management for Diabetes: Health Care System-Level Approaches for Improving Quality and Addressing Disparities. Current diabetes reports, 17(5), 31. https://doi.org/10.1007/s11892-017-0858-3

Tillotson, C.V., Bowden, S.A., Shan, M., Boktor, S.W., (2023). Pediatric Type 2 Diabetes. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK431046/