Type 2 diabetes

First Australian guidelines for paediatric type 2 diabetes

Wednesday, 1 Jul 2020

Australia’s first guidelines for paediatric type 2 diabetes which include a focus on high risk ethnic groups, have been released by the Australasian Paediatric Endocrine Group (APEG).

Specific recommendations for screening, assessment and management of child and adolescent type 2 diabetes are needed in an Australian context to reflect the six-fold increase in the condition among groups such as Indigenous Australians in recent years, according to the guideline authors

Driven by the rising levels of obesity, between 1990 and 2012 the incidence of paediatric diabetes increased from 4.5 to 31.1 per 100 000 person-years in Indigenous children in WA, and from 0 to 1.4 per 100 000 person-years in non-Indigenous children.

Higher rates of diabetes are also being seen in Pacific Islanders (5.9 per 100 000 person-years) and Māori people (4.1 per 100 000 person-years), they note.

“Published international guidelines currently exist, but the challenges and specifics to care for children and adolescents with type 2 diabetes which should apply to Australasia have not been addressed to date,” wrote the guideline authors, led by Dr Alexia Peña a paediatric endocrinologist at the Robinson Research Institute, University of Adelaide.

Key recommendations in the new guidelines include:

  • Targeted screening every 2-3 years for children and adolescents aged > 10 years in those who are overweight (BMI ≥ 85 and < 95%) or obese (BMI ≥ 95%) and who have one or more additional risk factors;
  • Tighter diabetes targets (HbA1c < 48 mmol/mol [< 6.5%]) for all children and adolescents due to longer disease duration and accelerated rate of developing complications;
  • Considering the use of newer medications such as GLP-1 receptor agonists and SGLT2 inhibitors that have beneficial effects on weight, under the guidance of a paediatric endocrinologist;
  • Considering bariatric surgery in selected cases of obesity;
  • The need to transition adolescents with type 2 diabetes to a diabetes multidisciplinary care team including an adult endocrinologist for their ongoing care.

The guideline authors say specific recommendations on T2D in children are needed because β-Cell function declines faster and diabetes complications develop earlier in paediatric type 2 diabetes compared with adult-onset type 2 diabetes.

“There are no consensus guidelines in Australasia for assessment and management of type 2 diabetes in paediatric populations and health professionals have had to refer to adult guidelines,” they note.

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