Screening, assessment and management of type 2 diabetes mellitus in children and adolescents: Australasian Paediatric Endocrine Group guidelines

Peña, Alexia S; Curran, Jacqueline; Fuery, Michelle; George, Christian; Jefferies, Craig; Lobley, Kristine; Ludwig, Karissa; Maguire, Ann; Papadimos, Emily; Peters, Aimee; Sellars, Fiona; Speight, Jane; Titmuss, Angela; Wilson, David I.; Wong, Jencia; Worth, Caroline; Dahiya, Rachana

doi:10.5694/mja2.50666

Cited by 31 publications

(51 citation statements)

References 45 publications

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“…Indigenous Australians and Maori/Pacifica are overrepresented among youth with type 2 diabetes in Australia and NZ captured by ADDN, and have higher risk of developing type 2 diabetes in youth combined with poorer health outcomes and a lower life expectancy 7,20,39 . These results support the recommendation for targeted screening for type 2 diabetes in overweight or obese youth from high‐risk populations (including Indigenous Australian and Maori) in the newly compiled guidelines for type 2 diabetes in youth from the Australasian Pediatric Endocrine Group 18 . Increasing data‐capture by expanding the number of ADDN centers, particularly into areas with a higher indigenous Australian population, will improve our understanding of type 2 diabetes in this high‐risk group.…”

Section: Discussionsupporting

confidence: 62%

“…However, waist circumference and waist/height ratio may be particularly useful to determine metabolic risk and provide an indication for screening in young people of Indigenous Australian and Maori/Pacifica descent. This is reflected in the recent APEG guidelines recommending screening in young people of Indigenous backgrounds with a waist/height ratio of > 0.5 18 . Furthermore, the higher HbA1c noted in the participants who presented in the normal weight range may partly reflect the difficulty in using BMI to predict metabolic risk.…”

Section: Discussionmentioning

confidence: 99%

“…Hypertension was defined according to the 2017 American Academy of Pediatrics Clinical Practice Guideline as a systolic and/or diastolic blood pressure > 95th percentile for participants aged <13 years and > 130/80 mmHg for participants aged ≥13 years 17 . Hypercholesterolaemia was defined as LDL cholesterol > 3.36 mmol/L (131 mg/dl) and hypertriglyceridemia > 1.7 mmol/L (150 mg/dl) based on the recent Australasian Pediatric Endocrine Group type 2 diabetes consensus guidelines 18 …”

Section: Methodsmentioning

confidence: 99%

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Type 2 diabetes in children and adolescents across Australia and New Zealand: A 6‐year audit from The Australasian Diabetes Data Network (ADDN)

et al. 2020

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Objectives To assess the clinical and demographic characteristics of children and adolescents across Australia and New Zealand (NZ) with type 2 diabetes. Methods We performed a descriptive audit of data prospectively reported to the Australasian Diabetes Data Network (ADDN) registry. Data were collected from six tertiary pediatric diabetes centers across Australia (New South Wales, Queensland, South Australia, Western Australia, and Victoria) and NZ (Auckland). Children and adolescents diagnosed with type 2 diabetes aged ≤ 18 years with data reported to ADDN between 2012 and 2017 were included. Age, sex, ethnicity, HbA1c, blood pressure, BMI, waist circumference and lipid profile at first visit were assessed. Results There were 269 cases of type 2 diabetes in youth reported to ADDN between 2012 and 2017. The most common ethnicities were Indigenous Australian in 56/243 (23%) and NZ Maori or Pacifica in 47 (19%). Median age at diagnosis was 13.7 years and 94% of participants were overweight or obese. Indigenous Australian and Maori/Pacifica children were younger at diagnosis compared with nonindigenous children: median 13.3 years (indigenous Australian); 13.1 years (Maori/Pacifica); 14.1 years (nonindigenous), p = 0.005. HbA1c was higher in indigenous Australian (9.4%) and Maori/Pacifica youth (7.8%) compared with nonindigenous (6.7%) p < 0.001. BMI‐SDS was higher in Maori/Pacifica youth (2.3) compared with indigenous Australian (2.1) and nonindigenous (2.2) p = 0.011. Conclusions Indigenous Australian and Maori/Pacifica youth in ADDN were younger and had worse glycaemic control at diagnosis of type 2 diabetes. Our findings underscore the need to consider targeted and earlier screening in these “high‐risk” populations.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Type 2 diabetes in children and adolescents across Australia and New Zealand: A 6‐year audit from The Australasian Diabetes Data Network (ADDN)

et al. 2020

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“…A family-based multicomponent lifestyle intervention, delivered by a pediatric dietitian experienced in the management of type 2 diabetes, is recommended alongside medical management of type 2 diabetes in youth, often aiming for weight loss. 12,14,15,[50][51][52] The American Diabetes Association 14 recommends intensive weight management as a component of the treatment plan for youth with type 2 diabetes but does not recommend a specific dietary approach. A carefully monitored and individualized VLED-based dietary intervention is recommended in some guidelines as a short-term (8-12 weeks) approach to achieve rapid weight loss and improve glycemic control in adolescents with obesity and type 2 diabetes.…”

Section: Guidelines For Use Of Vleds In Children and Adolescentsmentioning

confidence: 99%

“…A carefully monitored and individualized VLED-based dietary intervention is recommended in some guidelines as a short-term (8-12 weeks) approach to achieve rapid weight loss and improve glycemic control in adolescents with obesity and type 2 diabetes. [50][51][52] Overall, guidelines highlight a lack of evidence relating to specific dietary approaches beneficial for the management of type 2 diabetes in youth, representing an important area for further research. 14,[50][51][52] Guidelines for the use of dietary interventions in the management of pediatric obesity recommend screening for eating disorders prior to initiating treatment.…”

Section: Guidelines For Use Of Vleds In Children and Adolescentsmentioning

confidence: 99%

Current Perspectives on the Role of Very-Low-Energy Diets in the Treatment of Obesity and Type 2 Diabetes in Youth

Gow¹,

Pham-Short²,

Jebeile³

et al. 2021

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In both developed and developing countries, pediatric obesity and type 2 diabetes are an increasing public health concern: globally 5.6% of girls and 7.8% of boys aged ≥5 years have obesity. The incidence of type 2 diabetes has increased in youth in recent decades and disproportionately affects those from ethnic/racial minority groups and disadvantaged backgrounds. For the treatment of both conditions, conventional lifestyle intervention is frequently ineffective, access to bariatric surgery is very limited and many young people are unsuitable or unwilling to undergo surgery. A very-low-energy diet (VLED) provides a viable alternative and may be effective for weight reduction and improved glycemic control in youth, based on one systematic review. In particular, in the treatment of type 2 diabetes, a chart review and a pilot study both demonstrated that a VLED can reduce the requirement for medications, including insulin, and lead to the remission of diabetes. However, long-term follow-up and safety data remain limited and therefore a VLED is inconsistently recommended by clinical practice guidelines for the treatment of pediatric obesity and type 2 diabetes. In clinical practice, VLED use in children and adolescents is uniquely challenging due to intolerance of expected side effects, difficulty adhering to the highly restrictive diet and difficulty with behaviour change within the current social context and environment. Ultimately, more research, including larger, longer-term trials with comprehensive safety monitoring are required to strengthen the evidence base. This would inform clinical practice guidelines, which may facilitate more widespread utilization of VLED programs in the management of obesity and type 2 diabetes in youth.

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Consequences of Childhood and Adolescent Obesity

Anderson

Chew

2022

Clinical Obesity in Adults and Children

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Screening, assessment and management of type 2 diabetes mellitus in children and adolescents: Australasian Paediatric Endocrine Group guidelines

Cited by 31 publications

References 45 publications

Type 2 diabetes in children and adolescents across Australia and New Zealand: A 6‐year audit from The Australasian Diabetes Data Network (ADDN)

Type 2 diabetes in children and adolescents across Australia and New Zealand: A 6‐year audit from The Australasian Diabetes Data Network (ADDN)

Current Perspectives on the Role of Very-Low-Energy Diets in the Treatment of Obesity and Type 2 Diabetes in Youth

Consequences of Childhood and Adolescent Obesity

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