CE/CME

Pediatric T2DM: A Growing Threat to US Health


 

References

TREATMENT OF T2DM
Because relevant clinical data are limited, blood glucose (BG) goals should be individualized for each child with T2DM. As a rule of thumb, guidelines for BG goals in pediatric T1DM can serve as a reference for establishing BG goals in T2DM. Once adulthood is reached, BG goals reflect adult ranges.

FBG and A1C goals in pediatric T1DM are
• Younger than 4 years: 80 to 200 mg/dL and < 8.5%
• Between 5 and 11: 70 to 180 mg/dL and < 8.0%
• 12 and older: 70 to 150 mg/dL and < 7.5%.18

Primary care clinicians who manage pediatric patients with T2DM should consult with diabetes specialists at diagnosis and at least annually thereafter. Consultation is encouraged when treatment goals are not met.4

Lifestyle changes
The cornerstone of pediatric T2DM treatment is effective lifestyle intervention aimed at achievement of the patient’s BG goals and reduction of risks for microvascular and macrovascular complications.

Dietary modification methods can vary, depending on the caregivers’ and patient’s previous knowledge of nutrition. For families with little nutritional knowledge, the clinician may recommend the “plate method,” with half a plate designated for vegetables, one quarter for lean meats and protein, and one quarter for carbohydrates. As an alternative, the clinician may advise simple portion control, including smaller plate sizes and only one serving per meal. In addition, all sugared beverages should be avoided and daily milk intake should be limited.19

Behaviors surrounding meal preparation and snacking may also contribute to excessive caloric intake. Each day’s meals should be planned, and eating while at the computer, doing homework, or watching TV should be avoided.4

As time and the family’s comfort level permit, intensification of nutritional therapy can improve glycemic control through specific instruction regarding calorie counting and selection of low-fat and low-carbohydrate foods. Calorie intake of 900 to 1,200 kcal/d for children ages 6 to 12 and a minimum of 1,200 kcal/d for adolescents ages 13 to 18 are recommended for weight loss and improved body composition (see "Resources for Weight Management and Nutrition").4

Physical activity in the pediatric population can be derived from multiple sources, including physical education classes, after-school programs, sports and dance programs, and walks with the family or the dog. When discussing exercise recommendations, it is essential to consider any limitations imposed by the family’s finances and family members’ ­schedules.

Cardiovascular activity is recommended for 30 to 60 min or more every day or most days.4,14 To decrease excessive pursuit of sedentary activities, parents are urged to limit children’s nonacademic “screen time” to a maximum of two hours per day and to discourage the placement of video screens and television sets in children’s bedrooms.4

While lifestyle intervention remains the first-line treatment choice for pediatric T2DM, expert consensus is that less than 10% of pediatric patients reach glycemic control goals with lifestyle modifications alone.4

Next page: Treatment with metformin >>

Next Article:

Oral Bisphosphonates Linked with Lower Risk of Endometrial Cancer

Related Articles