Type 2 Diabetes in Children and Adolescents

In type 2 diabetes, lifestyle modifications focus on weight in the majority of children. Steps to improve food choices and manage food intake include eliminating sugary drinks, controlling portion size, switching to low-fat foods, and increasing fiber by eating more fruits and vegetables.

Choosing healthy foods can help control blood glucose and protect heart health. Children should focus on eating fruits and vegetables, whole grains, and high-fiber foods (for example, foods that have at least 3 grams of fiber or more per serving). Food should generally not contain many highly processed (refined) carbohydrates, particularly candy, baked goods (such as cookies, donuts, and pastries), and sugary drinks. Children should have no more than 4 to 8 ounces of 100% fruit juice per day. They should avoid regular soda, sweetened iced tea, lemonade, fruit punch, and sports drinks altogether. Children also should avoid foods high in saturated fats, such as baked goods, snack foods (such as potato chips and corn tortilla chips), deep-fried foods (such as french fries), and fast food. Some of these foods may still contain trans fats, common ingredients in certain commercial foods, which are being removed because they have been shown to be associated with an increased risk of heart disease.

Regular exercise is important because it improves glucose control and makes it easier to lose weight. Because vigorous exercise can cause a significant drop in blood glucose, some children with type 1 diabetes may need to consume some extra carbohydrates before and/or during a workout.

Children with type 2 diabetes usually are not treated in the hospital unless the diabetes is severe. Usually they are given medications to lower blood glucose levels (antihyperglycemic medications) at a regular doctor's office visit. Children with severe diabetes may need to be hospitalized to start insulin treatment. Less commonly, children with type 2 diabetes develop severe dehydration or, as in type 1 diabetes, Children with type 2 diabetes usually are not treated in the hospital unless the diabetes is severe. Usually they are given medications to lower blood glucose levels (antihyperglycemic medications) at a regular doctor's office visit. Children with severe diabetes may need to be hospitalized to start insulin treatment. Less commonly, children with type 2 diabetes develop severe dehydration or, as in type 1 diabetes,diabetic ketoacidosis (DKA).

MetforminMetformin is most commonly the first medication given by mouth (orally) for children and adolescents under 18 years of age. It is started at a low dose and often increased over several weeks to higher doses. It should be taken with food or given as an extended-release formulation to prevent nausea and abdominal pain.

InsulinInsulin is given to children who are hospitalized because of ketosis, DKA, or hyperosmolar hyperglycemic state. Insulin can often be stopped after several weeks once glucose levels return to normal after treatment with metformin. Children whose type 2 diabetes is not controlled by can often be stopped after several weeks once glucose levels return to normal after treatment with metformin. Children whose type 2 diabetes is not controlled bymetformin alone are given insulin or another medication called liraglutide. About half of adolescents with type 2 diabetes ultimately require insulin.

Liraglutide, Liraglutide,exenatide,exenatide, and dulaglutidedulaglutide are injectable medications that can be given to children over 10 years of age who have type 2 diabetes. SemaglutideSemaglutide is another injectable medication that can be given to people 12 years of age and over to manage type 2 diabetes and to treat obesity. These medications are known as GLP-1 agonists. GLP-1 is a hormone that has several roles in the body, including preventing more glucose from going into the bloodstream, slowing stomach emptying, and affecting the areas of the brain that process hunger and fullness (satiety). The GLP-1 agonists work by acting like the GLP-1 hormone and therefore help manage blood glucose by triggering the pancreas to release more insulin and by having an effect that reduces appetite and hunger, resulting in weight loss. GLP-1 agonists also help lower HbA1C levels. They may be given to children who are taking metformin but whose HbA1C level is not in the target range, or they can be given instead of metformin to children who cannot tolerate that medication.

EmpagliflozinEmpagliflozin is a medication taken by mouth that can be given to children over 10 years of age with type 2 diabetes. This medication is a sodium-glucose cotransporter-2 (SGLT2) inhibitor. Empagliflozin helps lower blood glucose levels by increasing the amount of glucose that is removed from the body in urine. It cannot be taken by people who have severe kidney disease or who are on dialysis. It can increase the risk of DKA and may cause urinary tract infections (UTIs) and genital yeast infections.

Other medications used for adults with type 2 diabetes may help some adolescents, but they are more expensive, and there is limited evidence for their use in children.

Some children who lose weight, improve their food choices, and exercise regularly may be able to stop taking the medications.

Because prompt treatment (such as changes in food choices, an increase in physical activity, and weight loss) may help prevent or delay the start of type 2 diabetes, children at risk of type 2 diabetes should be screened with a blood test that measures the hemoglobin A1C levels. This test should first be done when children are 10 years old or when puberty starts (if puberty occurred at a younger age) and should be repeated every 3 years if normal.

Some risk factors for type 2 diabetes can be modified. For example, children who are obese should lose weight, and all children should get regular exercise (see Nutrition and exercise).