Treatment of Type 2 Diabetes Mellitus in Children and Adolescents
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Janet H. Silverstein
ABSTRACT
The treatment of type 2 diabetes mellitus (DM) is directed at decreasing insulin resistance and increasing insulin secretion. α-Glucosidase inhibitors slow carbohydrate absorption, resulting in reduced postprandial hyperglycemia; thiazolidinediones increase insulin sensitivity, especially in muscle and adipocytes; metformin decreases hepatic gluconeogenesis; sulfonylureas result in prolonged increases in insulin secretion; and meglitinide causes rapid, short-lived increases in insulin secretion. A survey of 130 pediatric endocrinology practices in the USA and Canada indicated that 48% of children with type 2 DM were treated with insulin and 44% with one or more oral hypoglycemic agents (OHA). Of those treated with OHA, 71% received metformin, 46% sulfonylureas, 9% thiazolidinediones and 4% meglitinide. Similarly, in the three university-based diabetes centers in Florida, 50% of the children with type 2 DM were treated with OHA. Treatment is based on symptoms at presentation. Patients identified on routine testing are often treated with exercise and diet alone. Those who are mildly symptomatic at onset are often started on OHA. Patients with substantial ketosis, ketoacidosis or markedly elevated blood glucose levels are initially treated with insulin, followed by a tapering of the dose and the addition of an OHA after blood glucose control is established and symptoms subside. There are no studies of the efficacy or compliance with treatment for type 2 DM in adolescents. Treatment is currently based on the clinical experience with adults. Controlled clinical trials in children are essential.
© 2014 by Walter de Gruyter Berlin/Boston
Articles in the same Issue
- Titelei
- TABLE OF CONTENTS
- Foreword
- What Happens When Growth Hormone is Discontinued at Completion of Growth? Metabolic Aspects
- Growth Hormone Deficiency and Peak Bone Mass
- Optimal Strategy for Management of Pituitary Disease in the Growth Hormone-Deficient Teenager
- Ethical Dilemmas in Pediatric Endocrinology: Growth Hormone for Short Normal Children
- Evidence-Based Approach to Growth Hormone Replacement Therapy in Adults, with Special Emphasis on Body Composition
- Evidence-Based Growth Hormone Therapy Prediction Models
- New Paradigms for Growth Hormone Treatment in the 21st Century: Prediction Models
- Role of Insulin-like Growth Factor Monitoring in Optimizing Growth Hormone Therapy
- Knockout Mice Challenge Our Concepts of Glucose Homeostasis and the Pathogenesis of Diabetes Mellitus
- Type 2 Diabetes Mellitus in Children: Pathophysiology and Risk Factors
- Emergence of Type 2 Diabetes Mellitus in Children: Epidemiological Evidence
- Treatment of Type 2 Diabetes Mellitus in Children and Adolescents
- Diagnosis of Maturity-Onset Diabetes of the Young in the Pediatric Diabetes Clinic
- Thrifty Genotypes and Phenotypes in the Pathogenesis of Type 2 Diabetes Mellitus
- Estradiol: A Protective Factor in the Adult Brain
- Estrogen Treatment and Estrogen Suppression: Metabolic Effects in Adolescence
- Estrogen, Bone, Growth and Sex: A Sea Change in Conventional Wisdom
- Route-Dependent Endocrine and Metabolic Effects of Estrogen Replacement Therapy
- Telomerase and the Cellular Lifespan: Implications for the Aging Process
- Human Aging and Progeria
- A Role for the Somatotropic Axis in Neural Development, Injury and Disease
- Hypothalamic Growth Hormone-Insulin-like Growth Factor-I Axis across the Human Life Span
- The Lost Voice: A History of the Castrato
- SELECTED POSTER ABSTRACTS
- GROWTH. FETAL GROWTH. SGA
- SYNDROMES: TURNER. PRADER-WILLI. NOONAN. PHP. OTHERS
- GHD. HYPOPITUITARISM. KIGS
- METABOLIC. GENETIC. ADULT. ACROMEGALY
- GH. IGF. IGFBPs
- GROWTH IN SYSTEMIC DISEASE. CRI. RICKETS. STEROIDS
Articles in the same Issue
- Titelei
- TABLE OF CONTENTS
- Foreword
- What Happens When Growth Hormone is Discontinued at Completion of Growth? Metabolic Aspects
- Growth Hormone Deficiency and Peak Bone Mass
- Optimal Strategy for Management of Pituitary Disease in the Growth Hormone-Deficient Teenager
- Ethical Dilemmas in Pediatric Endocrinology: Growth Hormone for Short Normal Children
- Evidence-Based Approach to Growth Hormone Replacement Therapy in Adults, with Special Emphasis on Body Composition
- Evidence-Based Growth Hormone Therapy Prediction Models
- New Paradigms for Growth Hormone Treatment in the 21st Century: Prediction Models
- Role of Insulin-like Growth Factor Monitoring in Optimizing Growth Hormone Therapy
- Knockout Mice Challenge Our Concepts of Glucose Homeostasis and the Pathogenesis of Diabetes Mellitus
- Type 2 Diabetes Mellitus in Children: Pathophysiology and Risk Factors
- Emergence of Type 2 Diabetes Mellitus in Children: Epidemiological Evidence
- Treatment of Type 2 Diabetes Mellitus in Children and Adolescents
- Diagnosis of Maturity-Onset Diabetes of the Young in the Pediatric Diabetes Clinic
- Thrifty Genotypes and Phenotypes in the Pathogenesis of Type 2 Diabetes Mellitus
- Estradiol: A Protective Factor in the Adult Brain
- Estrogen Treatment and Estrogen Suppression: Metabolic Effects in Adolescence
- Estrogen, Bone, Growth and Sex: A Sea Change in Conventional Wisdom
- Route-Dependent Endocrine and Metabolic Effects of Estrogen Replacement Therapy
- Telomerase and the Cellular Lifespan: Implications for the Aging Process
- Human Aging and Progeria
- A Role for the Somatotropic Axis in Neural Development, Injury and Disease
- Hypothalamic Growth Hormone-Insulin-like Growth Factor-I Axis across the Human Life Span
- The Lost Voice: A History of the Castrato
- SELECTED POSTER ABSTRACTS
- GROWTH. FETAL GROWTH. SGA
- SYNDROMES: TURNER. PRADER-WILLI. NOONAN. PHP. OTHERS
- GHD. HYPOPITUITARISM. KIGS
- METABOLIC. GENETIC. ADULT. ACROMEGALY
- GH. IGF. IGFBPs
- GROWTH IN SYSTEMIC DISEASE. CRI. RICKETS. STEROIDS
