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New Guidelines for Managing Newly Diagnosed Type 2 Diabetes in Children and Adolescents

New guidelines provide a framework for clinicians managing type 2 diabetes in youth.

New guidelines developed by the American Academy of Pediatrics with support from the American Diabetes Association, the Pediatric Endocrine Society, the American Academy of Family Physicians, and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) provide a framework for clinicians managing type 2 diabetes in youth.  The guidelines are geared to general pediatricians, family physicians, pediatric endocrinologists, and other health care providers who deal with children.

The clinical practice guidelines, along with a separate technical document on screening for comorbidities, were published in the February issue of Pediatrics (published online January 28, 2013).

Key recommendations include the following:

• Start children/teens on insulin if it is unclear whether they have type 1 or type 2 diabetes. Continue insulin until the diabetes type can be definitively determined.
• Once a child or teen has been diagnosed with type 2 diabetes, prescribe metformin and lifestyle changes, including nutrition and physical activity.
• Monitor A1C levels every three months. If treatment goals are not being met, the physician should make appropriate changes to the treatment regimen.
• Home monitoring of blood glucose is appropriate for those using insulin, anyone changing their treatment regimen, those who aren't meeting their treatment goals, and during times of illness.
• Physicians should incorporate the Academy of Nutrition and Dietetics' Pediatric Weight Management Evidence-Based Nutrition Practice Guideline in nutrition counseling of children with type 2 diabetes.
• Children with type 2 diabetes should be encouraged to exercise at least 60 minutes a day and to limit their non-academic "screen time" (video games, television) to less than two hours a day.

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