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Australasia’s first guidelines for type 2 diabetes in children and adolescents

By Melanie Hinze
Australasia’s first guidelines for the screening, assessment and management of type 2 diabetes in children and adolescents advocate early detection and tighter diabetes targets.

Published recently in the Medical Journal of Australia, the guidelines offer advice on screening, diagnosis, diabetes education, glucose monitor­ing, multicomponent healthy lifestyle, pharmacotherapy, assessment and management of complications and comor­bidities, and transition of adolescents to adult services. Before the guideline’s publication, health professionals had to refer to interna­tional or adult guidelines when managing Australasian children with diabetes.

Approved by the Austral­asian Paediatric Endocrine Group (APEG), the guidelines also make the first specific recommendations for the screening and management of children and adolescents from Indigenous backgrounds in Australia and New Zealand.

Lead author, Dr Alexia Peña, a senior lecturer at the University of Adelaide’s Robinson Research Institute and a paediatric endocrinologist at the Women’s and Children’s Hospital Adelaide, said the prevalence of type 2 diabetes was increasing in children, especially in high­-risk Indi­genous children. Additionally, she said, around one­-third of children showed no symptoms of the disease.

‘When compared with adults with type 2 diabetes, the disease is more aggressive in children and complications appear earlier than they do for adults,’ she said. ‘Half of children with type 2 diabetes require insulin within two to five years of diagnosis, compared with adults who require insulin or other treatments more than five years after diagnosis.’

As children of Aboriginal, Torres Strait Islander, Maori or Pacific Islander descent have high diabetes rates at a younger age, along with a high incidence of obesity and cardiovascular disease, the guidelines advocate screening for all Indigenous children older than 10 years (or at the onset of puberty) who have one additional risk factor.

‘The most important take­ home message for GPs would be to facilitate early detection of diabetes with screening of high­-risk children’, Dr Peña said. ‘We are also advocating that due to the aggressiveness of the disease, these children need to be managed by specialist multidisciplinary care teams, with expertise in paediatric management.’

Recommended glycated haemoglobin targets in the guide­ lines are 48 mmol/mol or less (6.5% or less) for all children and adolescents.

The guidelines also recommend consideration of the use of newer medica­tions approved for adults with type 2 diabetes under the guidance of a paediatric endocrinologist, and the transition of adolescents with type 2 diabetes to a diabetes multidisciplinary care team, incorporating an adult endocrinologist, for their ongoing care.
Med J Aust 2020; doi: 10.5694/mja2.50666.