ADA Comprehensive Type 2 Diabetes Guidelines for Youth

ADA Comprehensive Type 2 Diabetes Guidelines for Youth

#ADA Position Statement  #2018


Addressing the specific needs of youth with type 2 diabetes (T2D) the American Diabetes Association (ADA) has issued “Evaluation and Management of Youth-Onset Type 2 Diabetes: A Position Statement by the American Diabetes Association”.

The statement’s objective is to provide an improved and up-to-date understanding of T2D in youth. It outlines pathophysiology, diagnosis, and risk factors, as well as components of lifestyle management, pharmacologic approaches to glycemic management and associated comorbidities, complications, and transition from pediatric to adult care.

“Research has indicated type 2 diabetes appears to be more aggressive in youth than in adults, with a faster rate of deterioration of β-cell function and poorer response to glucose-lowering medications. Furthermore, there is a higher risk for complications in people with earlier-onset type 2 diabetes, which is possibly related to prolonged lifetime exposure to hyperglycemia and other atherogenic risk factors, including insulin resistance, dyslipidemia, hypertension, and chronic inflammation. Thus, we must continue to make strides in recognizing the specific needs of youth and adolescents who are at-risk or diagnosed with type 2 diabetes”, the authors write in the document.

Criteria for the diagnosis of prediabetes and diabetes:-

Prediabetes

• A1C 5.7% to <6.5% (39 to <48mmol/mol)

• IFG: fasting glucose ≥100 but <126 mg/dL (≥5.6 but <7.0 mmol/L)

• IGT: 2-h plasma glucose ≥140 but <200 mg/dL (≥7.8 but <11.1 mmol/L) during an OGTT

Diabetes

•    A1C ≥6.5% (≥48 mmol/mol) OR

•    FPG ≥126 mg/dL (7.0 mmol/L) OR

•    2-h plasma glucose ≥200 mg/dL (11.1 mmol/L) during an OGTT OR

•   In a pt with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose >200 mg/dL (11.1 mmol/L)

 

The guidance document addresses the following topics:-

1.  Risk, screening, and diagnosis
2.  Glycemic targets
3.  Lifestyle management
4.  Pharmacologic approaches to glycemic management
5.  Metabolic surgery
6.  Prevention and management of diabetes complications
7.  Non-alcoholic fatty liver disease
8.  Obstructive Sleep Apnea
9.  Polycystic Ovary Syndrome
10. CVD
11. Transitioning from pediatric to adult care

Some of the key recommendations are:-

•  Risk-based screening for prediabetes and/or T2D should be considered after the onset of puberty or after 10 years of age, whichever occurs earlier, in children and adolescents who are overweight (BMI ≥ 85th percentile) or obese (BMI ≥95th percentile) A and who have additional risk factors for diabetes

•  Use fasting plasma glucose, 2-h plasma glucose after 75-g OGTT  (oral glucose tolerance test (OGTT), or A1C to test prediabetes or diabetes

•  A1C should be measured every 3 months

•  A reasonable A1C goal for most children and adolescents with type 2 diabetes treated with oral agents alone is < 7%

•  More stringent A1C goals (such as < 6.5%) may be appropriate for selected individual patients if they can be achieved without significant hypoglycemia or other adverse effects of treatment. Appropriate patients might include those with short duration of diabetes and lesser degrees of b-cell dysfunction and patients treated with lifestyle or metformin only who achieve significant weight improvement

•  Given the necessity of long-term weight control and lifestyle management for children and adolescents with type 2 diabetes, lifestyle intervention should be based on a chronic care model and offered in the context of diabetes care

•  In incidentally diagnosed or metabolically stable patients (A1C < 8.5% and asymptomatic), metformin is the initial pharmacologic treatment of choice if renal function is normal

•  Youth with marked hyperglycemia (blood glucose ≥250 mg/dL, A1C ≥8.5%) without acidosis at diagnosis who are symptomatic with polyuria, polydipsia, nocturia, and/ or weight loss should be treated initially with basal insulin while metformin is initiated and titrated

• In patients with ketosis/ ketoacidosis, treatment with subcutaneous or intravenous insulin should be initiated to rapidly correct the hyperglycemia and the metabolic derangement. Once acidosis is resolved, metformin should be initiated while subcutaneous insulin therapy is continued

• In individuals presenting with severe hyperglycemia (blood glucose ≥600 mg/dL), assess for hyperglycemic hyperosmolar nonketotic (HHNK) syndrome

• If the glycemic target is no longer met using metformin alone, or if contraindications or intolerable side effects of metformin develop, basal insulin therapy should be initiated

• Optimal cholesterol goals are LDL < 100 mg/dL (2.6 mmol/L), HDL > 35 mg/dL (0.905 mmol/L), triglycerides < 150 mg/dL (1.7 mmol/L)

• If LDL cholesterol remains above goal after 6 months of dietary intervention, initiate therapy with statin, with goal of LDL <100 mg/Dl

• Oral contraceptives for treatment of PCOS are not contraindicated for girls with type 2 diabetes

• Youth with type 2 diabetes should be transferred to an adult-oriented diabetes specialist when deemed appropriate by the patient and provider

 

 

About the ADA
Founded in 1940, the American Diabetes Association (ADA) is the nation’s leading voluntary health organization whose mission is to prevent and cure diabetes, and to improve the lives of all people affected by diabetes. The ADA drives discovery by funding research to treat, manage and prevent all types of diabetes, as well as to search for cures; raises voice to the urgency of the diabetes epidemic; and works to safeguard policies and programs that protect people with diabetes.

Note: This list is a brief compilation of some of the key points included in the guidelines and is not exhaustive and does not constitute medical advice. Kindly refer to the original publications here: https://pxmd.co/P5ChW


About Author
Dr. Prachi Chhimwal
Dr. Prachi Chhimwal is an Editor at PlexusMD and is a part of the Engagment Team. She curates the Technical Content posted daily on the news feed. She graduated from Army College of Dental Sciences (B.D.S) and went on to pursue her post-graduation (M.D.S) in Oral & Maxillofacial Pathology. After a decade in the field of dentistry she took a leap of faith and joined PlexusMD. A badminton enthusiast, when not working you can find her reading, Netflixing or enjoying stand-up comedy shows.
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