| Abstract: |
This review article presents pediatric nurse practitioners with the most recent information about type 2 diabetes in children and adolescents, summarizes current understanding about diagnosis, and outlines treatment options. Although children and adolescents are usually diagnosed with type 1 diabetes, within the past 10 years children as young as 8 years old have been diagnosed with the type 2 diabetes. Type 2 diabetes in youth is an emerging disease, so its natural history is not well understood. Risk factors for type 2 diabetes in children and adolescents are similar to those in adults, including non-European ancestry, family history of type 2 diabetes, obesity, insulin resistance, and age. African American and Hispanic youth are at greater risk than white youth. The initial assessment of children and adolescents with a potential diagnosis of diabetes is critical. Although youth with type 2 diabetes may or may not have the classic symptoms of polydipsia, polyuria, and polyphagia, they often have features associated with insulin resistance syndrome such as dyslipidemia, hyperglycemia, obesity, hypertension, polycystic ovarian syndrome, and acanthosis nigricans. Blood glucose levels are essential to the diagnosis of diabetes, but additional laboratory measures are also important. The aim of treatment is to normalize blood glucose and glycosylated hemoglobin values. Fundamental to this aim is an individualized plan for nutrition and activity. The choice of pharmacologic management will depend on the child's clinical presentation. Currently, insulin and metformin are the only drugs approved by the Food and Drug Administration for the treatment of diabetes in children; however, selected oral medications have been used with success. Diabetes self management education is also an essential component in the management of diabetes. Education must focus on psychomotor skills, medical nutrition therapy, and physical activity. Routine follow up care should occur every 3 to 4 months. Primary prevention activities include counseling all patients about the importance of a healthy diet and exercise and monitoring physical development. The article presents a case study and discusses the nursing and research implications of type 2 diabetes in youth. 1 figure. 2 tables. 28 references. (AA-M). |