While taking into consideration cultural attitudes toward diabetes, food and weight loss, clinicians should motivate children and adolescents with type 2 diabetes to exercise moderately to vigorously at least one hour daily. The guideline recommended limiting screen time to no more than 2 hours a day.

The committee noted that failure to alter lifestyle often stems from lack of follow-up, depression in teenagers, and peer pressure.

Younger patients typically adapt better to behavioral changes, with commensurately better outcomes, the guideline noted.

The recommendations emphasized that physicians should have realistic expectations for behavioral changes in children. Asking pediatric patients and their families to maintain diets and eating behaviors requires sensitivity to the family’s understanding of the disease. Cultural sensitivity is important, the guidelines cautioned, because type 2 diabetes disproportionately affects minority populations.

The committee also recommended that primary care physicians monitor HbA1c concentrations every 3 months and increase treatments if goals are not met, and monitor blood glucose with finger-stick tests for those taking insulin to avoid hypoglycemia.

Primary care physicians should partner with a specialist to ensure the best outcomes for pediatric patients, the guideline urged as well.

Because of the limitations of existing evidence, the guideline authors emphasized that the recommendations apply only to nonpregnant children and teens 10 to 17 years old.

The guidelines do not apply to children and teens with blood glucose values that fall short of criteria for type 2 diabetes, such as those with impaired fasting plasma glucose (in the range of 100 to 125 mg/dL) or impaired glucose tolerance (140 to 200 mg/dL in a 2-hour oral glucose tolerance test).

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Primary source: Pediatrics
Source reference: Copeland K, et al “Management of newly diagnosed type 2 diabetes mellitus (T2Dm) In children and adolescents” Pediatrics 2013; DOI: 10.1542/peds.2012-3494.