Donya Currie is the editor of The Free Lance-Star's Healthy Living section and Healthy Life Virginia newsletter.
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New diabetes guidelines a sign of changing times
Type 2 diabetes used to be so uncommon in children that it was referred to as adult onset diabetes. If kids had diabetes, they almost always had Type 1, aka juvenile diabetes. The difference: While both kinds of diabetes are influenced by genes, only one kind — Type 2 — is linked to weight problems.
But things have changed — so much that the American Academy of Pediatrics just issued guidelines, for the first time, helping pediatricians care for young patients with Type 2 diabetes. The guidelines are a tangible sign of how many kids are now experiencing adult health problems because of bad eating and physical inactivity.
“It used to be that the vast majority of kids with new onset diabetes had Type 1 Diabetes,” said Dr. Nimali Fernando, a Fredericksburg pediatrician, in an email. “That has changed with the epidemic of childhood obesity, such that one-third of new cases of diabetes today are type 2, which was previously a disease of overweight adults.”
The AAP’s guidelines, released online this week, were created in collaboration with the American Diabetes Association, the Pediatric Endocrine Society, the American Academy of Family Physicians, and the Academy of Nutrition and Dietetics. They target children in the 10-18-year-old range.
Among other recommendations, the guidelines say pediatricians should:
- Start diabetic patients on insulin if it’s unclear whether they have Type 1 or Type 2 diabetes. The medicine should be started before waiting to see if lifestyle changes, such as a modified diet, help.
- Prescribe the drug metformin for patients who have been diagnosed with Type 2 diabetes, and also prescribe a modified diet created in consultation with a registered dietitian.
- Encourage patients with Type 2 diabetes to exercise for at least 60 minutes a day and spend less than two hours a day in front of TV, computer or other screens not being used for academics.
Fernando said the guidelines will be beneficial in helping physicians who trained to treat children navigate this “disease of overweight adults” in kids.
“Many patients with type 2 don’t have easy access to pediatric endocrinologists, so the general pediatrician needs to know how to manage these patients,” Fernando said. “I like that lifestyle modification was recommended in conjunction with medication.”
Fernando is the founder of The Doctor Yum Project, a local non-profit devoted to combating childhood obesity and related diseases by helping families embrace healthier eating habits. She leads free shopping classes to help parents make healthy and budget-friendly choices in local grocery stores, and she also holds cooking classes for children designed to help them develop a taste for a large variety of fresh, healthy foods.
Not all people with Type 2 diabetes are overweight. “Being overweight is a risk factor for developing this disease, but other risk factors such as family history, ethnicity and age also play a role,” says the American Diabetes Association.
Still, inactivity and obesity are two of the biggest reasons people develop the disease, which ups the risk of suffering serious health problems such as a heart attack or stroke. Diabetes also is linked to a host of other problems including skin disorders, vision loss, kidney disease and nerve damage.
“In the end, the greatest impact pediatricians can have on type 2 diabetes in children is to make sure we prevent obesity by engaging in rigorous counseling on diet and exercise,” Fernando said.
You can read more about the new guidelines here. For tips on helping children become healthier eaters, visit doctoryum.com, where you can find recipes and more information on raising healthy children. To learn more about diabetes in general, visit the American Diabetes Association website by clicking here.