Pediatric DM type 2

Question 1

Risk factors for type 2 DM in children and youth

Answer 1

• Risk factors:
		○ Family member (first or second degree)
		○ Member of high risk population
		○ Obesity
		○ Impaired glucose tolerance
		○ PCOS
		○ Gestational DM
		○ Acanthosis nigricans
		○ HTN
		○ Dyslipidemia
		○ NAFLD
Atypical antipsychotic meds

Question 2

What are some protective measures against youth-onset DM2?

Answer 2

• breastfeeding
• increase activity
• reduce sweet drinks
• limit screen time
• family based health behaviour interventions

Question 3

What is the recommended screening test for DM2 in children and youth?

Answer 3

fasting plasma glucose

OGTT if severe obesity or multiple risk factors
A1C in combo with other markers

Question 4

How would you differentiate between DM1 and 2 on initial presentation?

Answer 4

both can present in DKA

test for diabetes autoantibodies to r/o DM type 1

Question 5

What is the target A1C for children and youth with DM2

Answer 5

7. 0 or under

* need to involve entire family in interventions

Question 6

What are some lifestyle strategies for management of DM2 in children and youth?

Answer 6

• 60 min daily of moderate physical activity
• limit screen time to <2 hours/day
• limit sedentary/sitting time
• diet
• first and second hand smoke

need to involve entire family

Question 7

What is the pharm treatment of type 2 DM in children and youth?

Answer 7

• start insulin if A1C over 9.0% and severe metabolic decompensation
• insulin can be weaned once glycemic target reached
• metformin 500 mg daily x first 7 days then titrate up

if stable (A1C <9.0% and no/minimal symptoms), start metformin with healthy behaviour interventions

• if target not met in 3-6 months from dx, start basal insulin
• if target still not met on basal insulin and metformin, start prandial insulin

-none of the non-insulin anti-hyperglycemic agents are approved for use in kids

Question 8

Screening for complications in children with DM2

NEPHROPATHY

• test
• frequency

Answer 8

morning ACR
*repeat in 1 month if abnormal

annual, start at time of dx

Question 9

Screening for complications in children with DM2

RETINOPATHY

• test
• frequency

Answer 9

diabetic eye exam

annual, start at time of dx

Question 10

Screening for complications in children with DM2

NEUROPATHY

• test
• frequency

Answer 10

history and physical

• numbness, pain, cramping, paresthesia
• sensation, vibration, light touch, ankle reflex

annual, start at time of dx

Question 11

Screening for complications in children with DM2

DYSLIPIDEMIA

• test
• frequency

Answer 11

fasting lipids

annual, start at time of dx

Question 12

Screening for complications in children with DM2

HYPERTENSION
-frequency

Answer 12

at every DM visit
minimum twice per year

start at time of dx

Question 13

What are 5 other complications of DM2 unique to children and youth?

(NPO MOOD and FOOD)

how would you screen?
how often?

Answer 13

NAFLD
-annual ALT/abdo US

PCOS
-annual, hx and physical

OSA
-annual, hx

DEPRESSION
-annual, hx

BINGE EATING
-annual, hx

Question 14

Screening for type 2 DM in children and youth

-how often should this be done?

Answer 14

every 2 years using combo of A1C and fasting or random glucose

3+ risk factors in non-pubertal children starting age 8

OR

2+ risk factors in pubertal children