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First-ever health guidelines issued for diabetic kids

The American Academy of Pediatrics issued the first-ever guidelines for type 2 diabetic children between the ages of 10 and 18 on Monday.

Childhood obesity is a growing epidemic. In 1980, only 7 percent of kids between 6 to 11 years old were obese, according to the Centers of Disease Control and Prevention. That number jumped to 20 percent in 2008. Likewise, obesity in adolescents aged 12 to 19 grew from 5 percent to 18 percent in the same time period. Overall, more than one-third of children and adolescents are overweight or obese.

As a result, obesity-related illnesses have increased in kids. Obese children have high risk factors for cardiovascular disease like high cholesterol or high blood pressure; prediabetes or type 2 diabetes; bone and joint problems; sleep apnea and social and psychological issues. In the long run, an obese child is more likely to be obese as an adult and face a lifetime of heart disease, type 2 diabetes, stroke, several types of cancer and osteoarthritis.

"Pediatricians and pediatric endocrinologists are used to dealing with type 1 diabetes. Most have had no formal training in the care of children with type 2," author Dr. Janet Silverstein, division chief of pediatric endocrinology at the University of Florida, in Gainesville, Fla., told HealthDay.

"The major reason for the guidelines is that there's been an increase in overweight and obesity in children and adolescents, with more type 2 diabetes in that population, making it important for general pediatricians, as well as endocrinologists to have structured guidelines to follow," she added.

The new guidelines recommend treatment with insulin for all patients who are ketotic or in ketoacidosis -- a condition where the body has a high level of ketones, an organic compound that breaks down fats and fatty acids. They also recommend insulin for those who are markedly hyperglycemic or have high blood pressure, or in those individuals where it is not clear if they have type 1 or type 2 diabetes. It is often hard to diagnose the difference between type 1 and type 2 diabetes in children, and if they are overweight it makes diagnosis even more difficult.

In all other cases, the anti-diabetic drug metformin is advised along with lifestyle modification programs that encourage nutrition and physical activity.

In addition, the American Academy of Pediatrics recommended other rules for monitoring young patients' glycemic levels and how to get them to start insulin routines. Hemoglobin A1c levels, which measure the last three months of blood sugar, should be checked every three months, and home monitoring of glucose is recommended for those using insulin so it can be seen quicker if they are not using the medicine regularly.

They also recommended that children with type 2 diabetes get at least 60 minutes of exercise a day and non-academic "screen time" including video games, television and computer usage should be less than two hours a day.


Dr. Rubina Heptulla, who works at Children's Hospital at Montefiore in the Bronx, said to TIME the rules are necessary today. Heptulla, who was not involved in the study, sees about three children a week now that have diabetes and about half of them are Type 2.

"I did not see this as a resident or fellow," Heptulla explained. "We would not have had these guidelines 10 years ago because there were not many cases. Now these guidelines are very relevant."

She advocated for encouraging a healthy lifestyle before the child developed the chronic disease.

"The way to make a difference is before they develop diabetes," Heptulla says.

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