An expert opinion on the management of type 2 diabetes mellitus in children and adolescents
Rajesh Rajput1, Sujeet Jha2, Jayanta Kumar Panda3, Appalavenkata Kandregula Subrahmanyam4, Sambit Das5
1 Department of Endocrinology, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Medical Road, Rohtak, Haryana 124001, India
2 Institute of Endocrinology Diabetes and Metabolism, Max Super Specialty Hospital, South Block, 2, Press Enclave Road, Saket, New Delhi 110017, India
3 Metabolic and Critical Care Medicine, Department of Medicine, SLN Medical College, Pujariput, Koraput, Odisha 764020, India
4 King George Hospital, Andhra Medical College, Vishakhapatnam, Andhra Pradesh, India
5 ACODE and Sugar Clinics, Apollo Hospitals, Bhubaneswar, Odisha, India; Hitech Medical College and Hospital, Hi-Tech Hospital Road, Pandra, Rasulgarh, Bhubaneswar, Odisha 751025, India
Dr. Sambit Das
ACODE and Sugar Clinics, Apollo Hospitals, Bhubaneswar, Odisha.
Source of Support: None, Conflict of Interest: None
Type 2 diabetes mellitus (T2DM) is an emerging epidemic among children and adolescents. There is a lack of comprehensive guidance to clinicians for the management of T2DM in this patient population. An expert panel of diabetes specialists from India reviewed the available literature, discussed, and proposed six recommendations on the identification of risk factors leading to the development of T2DM, diagnosis of T2DM, and non-pharmacological and pharmacological management of T2DM in children and adolescents. According to these recommendations, the most common risk factors leading to T2DM in children are obesity, metabolic syndrome, insulin resistance, family history, puberty, and genetic abnormalities. Diagnosis of T2DM in children and adolescents should be based on plasma glucose levels, with recommendation to test glycated hemoglobin levels quarterly. Lifestyle modifications may help in improving outcomes. Among pharmacological treatments, insulin and metformin are currently the approved first-line therapies and liraglutide is recommended if glycemic targets are no longer met with metformin or insulins. Early identification of risk factors, along with early diagnosis and initiation of insulin therapy with lifestyle modifications, may help in delaying the chronic complications associated with T2DM in children and adolescents.