Tuesday, January 29, 2013 AAP Issues First Guidelines on Managing Type 2 Diabetes in Children The 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. The 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.