Family Matters

Pediatricians Issue First-Ever Diabetes Guidelines for Children

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With childhood obesity rates on the rise, pediatricians are doing something they couldn’t have imagined a need for a decade ago: they’re debuting guidelines for managing weight-related diabetes among youngsters.

Children have long been diagnosed with Type 1 diabetes, in which the body fails to make enough insulin-producing cells to process glucose in the blood, but doctors are now seeing an increasing number of children with type 2 diabetes, in which fat cells that enlarge with weight gain thwart the body’s ability to break down sugars. Up to a third of cases being diagnosed in kids these days are Type 2, which generally develops later in life, generally after age 40. “We’re seeing it much more than we did before,” says Dr. Janet Silverstein, co-author of the new American Academy of Pediatrics guidelines on diabetes and professor of pediatrics at the University of Florida. “Many pediatricians were never trained in managing Type 2 because it just wasn’t a disease we used to see. It was a disease of adulthood. But as we’re seeing more obesity in kids, we’re seeing adult diseases in childhood.”

As pediatricians continue to encounter more children with diabetes, the Academy decided there was a need for clear, consistent advice on how to treat these kids. The group’s first recommendation: screen all obese children for diabetes. Next: figure out what type of diabetes they have.

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The guidelines, which are the first of their kind for kids between the ages of 10 and 18, were developed in collaboration with the American Diabetes Association, the Pediatric Endocrine Society, the American Academy of Family Physicians and the Academy of Nutrition and Dietetics.

They emphasize the importance of distinguishing between type 1 and type 2 to determine an appropriate treatment plan. Children with type 2 don’t necessarily need insulin. They may initially be treated with medication that increases their sensitivity to insulin. And they should be encouraged to move: doctors should advise them to exercise at least an hour a day and limit screen time that’s not related to schoolwork to under two hours a day.

But children diagnosed with type 1 diabetes always need insulin to regulate glucose levels in their blood. If doctors aren’t certain which kind of diabetes a patient has, they should start with insulin therapy until a more refined diagnosis can be made.

Each week at Children’s Hospital at Montefiore in the Bronx, Dr. Rubina Heptulla sees up to three children who have recently been diagnosed with diabetes; about half have Type 2. Heptulla, chief of the division of pediatric endocrinology and diabetes, says the number of cases of diabetic children is a pediatric “epidemic.” “I did not see this as a resident or fellow,” says Heptulla, who was not involved in developing the guidelines. “We would not have had these guidelines 10 years ago because there were not many cases. Now these guidelines are very relevant.”

While medications can control blood sugar levels, the guidelines also stress that parents and patients be aware that changes in diet and exercise can also be important in reducing risk of the disease. Pediatricians should be advising overweight and obese children to lose weight, and to exercise regularly. Studies of such diet and physical activity changes in adults showed that many diabetics could reduce their dependence on medications, and people who are likely to develop the disease could lower their risk by 58% compared to those who didn’t change their eating and exercise habits. Heptulla says the same should be true among children. “The way to make a difference is before they develop diabetes,” she says.

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