American Academy of Pediatrics
(AAP) recently issued guidelines to provide
evidence-based recommendations on managing type 2 diabetes in children aged 10
to 18. The guidelines are the first of their kind for this age group.
The recommendations suggest
integrating lifestyle modifications, including diet and exercise, in concert
with medication rather than as an isolated initial treatment approach.
Specifically, clinicians should encourage patients to engage in
moderate-to-vigorous exercise for at least 60 minutes daily and to limit
nonacademic “screen time” to less than 2 hours a day. "Physical activity
is an integral part of weight management for prevention and treatment of
T2DM," write the authors. They suggest that when prescribing physical
exercise, clinicians should be sensitive to the needs of children, adolescents,
and their families. Noting that routine, organized exercise may be beyond the
family's logistical and/or financial means, it is "most helpful to
recommend an individualized approach that can be incorporated into the daily
routine, is tailored to the patients' physical abilities and preferences, and
recognizes the families' circumstance."
The guidelines also call for
additional research. In particular the authors recommend studies that delineate
whether using lifestyle options without medication is a reliable first step in
treating selected children with type 2 diabetes, explore the efficacy of school
and clinic-based diet and physical activity interventions to prevent and manage
pediatric type 2 diabetes, and investigate the association between increased
"screen time" and reduced physical activity with respect to type 2
diabetes risk factors.
guidelines were written in consultation with the American Diabetes Association,
the Pediatric Endocrine Society, the American Academy of Family Physicians, and
the Academy of Nutrition and Dietetics.