Guidelines for assessment and management of type 2 diabetes in young people
Wednesday, 14 April 2021
Australian guidelines to assess and manage type 2 diabetes in children and adolescents have been produced to help treat the growing number of young people diagnosed with the condition.
The rate of new cases of diabetes in children and adolescents is thought to be linked to the rise in obesity levels.
The children most at risk
Those most at risk are children and adolescents of Aboriginal, Torres Strait Island, Pacific Island or Maori descent.
One study showed that Indigenous children and adolescents in Western Australia had rates of diabetes six times higher than non-Indigenous young people.
Concerning outcomes for young ones
Type 2 diabetes in young people is concerning as the health outcomes are even more serious than those who are diagnosed with type 1 diabetes, or adults diagnosed with type 2 diabetes.
The complications of diabetes, including amputations, blindness, heart and kidney disease, and stroke, are seen earlier in those diagnosed at a young age. This can reduce quality of life and life expectancy.
Until last year, Australian guidelines for type 2 diabetes have focused on adult care only.
Identify diabetes early
A working group organised by the Australasian Paediatric Endocrine Group (APEG) developed new guidelines specifically for children and adolescents.
The guidelines help to advise health care providers on all aspects of screening and management of diabetes in children and adolescents.
It is important to identify diabetes early, and to link into health care providers for treatment at an early stage to get the best long-term health outcomes.
The guidelines include a section on special considerations for children and adolescents from Indigenous backgrounds.
Highlights of the guidelines
Key features of the new guidelines include the need for:
- Screening for diabetes every 2 to 3 years for children aged 10 years or older who have any risk factors: overweight, obesity, family history of gestational or type 2 diabetes, high blood pressure, high cholesterol levels, fatty liver, polycystic ovarian disease, small for gestational age, or use of medications for depression, anxiety, insomnia and mood disorders.
- Tighter diabetes targets than adults (HbA1c < 48 mmol/mol [< 6.5%])
- Access to a specialised multidisciplinary team for young people with diabetes
- Regular appointments with the health care team
- An individual plan for children to do their own blood glucose monitoring
- Lifestyle education which is individualised, age appropriate and includes the family
- Transition to a specialised multidisciplinary adult team.
The guidelines also provide advice on medications and insulin.
Barriers to care
They address specific barriers and issues known for young people including engagement with health care providers, the need for positive and non-judgmental language, addressing specific beliefs and concerns, and the involvement of family and peers.
Additional guidance on access to healthy foods, social and financial concerns, travel considerations, and other health needs are outlined.
Multidisciplinary team for life
The seriousness of this condition is highlighted by the need for a specialised multidisciplinary team for life.
These new guidelines emphasise the challenges and needs involved in supporting young people with diabetes. The guidelines will help them and their health care providers to achieve positive outcomes.