What are the ADA guidelines for youth-onset type 2 diabetes mellitus (DM)?

Updated: Sep 27, 2021
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Answer

In November 2018, the ADA released a position statement the evaluation and management of youth-onset type 2 diabetes. It includes the following points [401] :

  • Severe peripheral and hepatic insulin resistance occurs when type 2 diabetes develops in adolescents with obesity, with peripheral insulin sensitivity being about 50% below that of adolescents who have obesity without diabetes; the disposition index (the mathematically described product of insulin sensitivity and β-cell function) in youth with both obesity and type 2 diabetes is about 85% lower
  • Risk-based screening should be considered in overweight and obese children over age 10 years or who have commenced puberty
  • Risk factors for type 2 diabetes in youth should be taken into account, including whether the child’s mother has a history of diabetes or experienced gestational diabetes while pregnant with the child, as well as whether close family members have a history of type 2 diabetes; other risk factors to consider include signs of insulin resistance, as well as the youth’s ethnicity (ie, whether he or she is from a non-Caucasian background, such as African American or Latino)
  • As part of diagnosis, a panel of pancreatic autoantibodies should be employed to exclude the presence of autoimmune type 1 diabetes
  • Adherence to medication therapy and the impact of treatment on weight should be taken into account when glucose-lowering agents and other medications are being chosen for patients who are overweight or obese
  • A chronic approach to lifestyle management should be employed, with education, weight management, exercise, nutrition, and psychological factors emphasized
  • Education and lifestyle management programs need to be culturally and contextually sensitive
  • If their BMI is greater than 35 kg/m 2, uncontrolled glycemia and/or serious comorbidities are present, and lifestyle and pharmacologic approaches have failed, adolescents with type 2 diabetes may be considered for metabolic surgery (but only by an experienced surgeon and only in tandem with input from a multidisciplinary team that also includes an endocrinologist, a nutritionist, a behavioral health specialist, and a nurse)
  • A transfer to adult care should be arranged only when the patient and provider deem it appropriate

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