American pediatricians, alarmed by the rise of Type 2 diabetes in children and failure rates for oral medication, are recommending early aggressive treatments with insulin shots for many youth who are diagnosed with the disease.
The recommendation will be made Monday, when the American Academy of Pediatricians issues its first-ever clinical guidelines for Type 2 diabetes—a grim milestone for a disease that used to be rare in children before obesity rates began to rise.
As a result of the guidelines, which also recommend kids improve their diets and get more exercise, children may now have to begin often temporary insulin regimens like those used to treat Type 1, the autoimmune form of the disease, which requires immediate and lifelong insulin injections. Children who don’t need insulin treatment should be started on the oral diabetes drug metformin, according to the recommendation.
The guidance, published in the journal Pediatrics, comes as doctors have recognized that childhood Type 2 diabetes could lead to complications earlier than it does with adult patients and that lifestyle changes alone may not control the obesity-linked disease. It also shows how it can be difficult to distinguish initially between Type 2 and Type 1 in children, particularly as the growth of the disease means more cases are handled by family doctors without good access to specialists.
«Diabetes is an expensive disease, and complications are even more expensive,» said Janine Sanchez, director of pediatric diabetes at the University of Miami Miller School of Medicine, who wasn’t involved in drafting the new guidelines. «We definitely want to make sure that these kids are taken care of, because in the end we are all going to pay for that.»
Three decades ago, Type 2 diabetes was generally limited to adults. Now, one out of three new diabetes cases among patients under 18 is Type 2. Doctors say they have diagnosed the disease in children as young as 6.
The number of American children with Type 2 diabetes isn’t well established, but estimates by the U.S. Centers for Disease Control and Prevention magazine suggest tens of thousands are affected. The CDC says about 17% of Americans under age 20—about 12.5 million people—are obese and at increased risk for the disease. Since 1980, obesity among the young has almost tripled, the agency says.
Type 2 diabetes occurs when the body can’t effectively use insulin, which regulates blood sugar, and the disease can affect the body’s ability to produce the hormone. It can usually be controlled by lifestyle changes, which makes it distinct from Type 1, in which the immune system destroys pancreatic beta cells that produce insulin.
Type 2 raises the risk of heart attacks and strokes, kidney disease, blindness, amputations and nerve damage. Complications such as kidney disease and nerve damage are happening faster in children with Type 2 than adults with Type 2 or children with Type 1, Dr. Sanchez said.
«The whole process seems to be accelerated,» she said.
Concerns about those complications were heightened last year, when a study showed that metformin, the only drug approved in the U.S. for treatment of children with Type 2 diabetes, was much less effective in children than for adults.
Rubina Heptulla, chief of the division of pediatric endocrinology and diabetes at the Children’s Hospital at Montefiore in New York, said that unlike adult guidelines the pediatric guidelines recommend medication be started immediately in addition to diet and exercise changes. Dr. Heptulla also wasn’t involved in writing the new pediatric guidelines. The use of insulin injections can in many cases be temporary, doctors say.
Claudia Murrietta’s 11-year-old daughter, Delaney, was suffering nose bleeds, dizziness and numbness in her hands and feet. A physical revealed that her blood-sugar levels were very high, and she was started on oral doses of metformin. It wasn’t effective. After a week, Delaney was admitted to the hospital for four days and put on insulin.
«When they told me your daughter needs to go on insulin it was devastating,» said Ms. Murrietta, 32, who works in insurance claims and lives in Laveen, Ariz. After eliminating sugary drinks and rationing portions, Delaney lost 15 pounds in eight weeks, no longer needs insulin shots and is enrolled in after-school sports. «We now watch what we eat and we are more active,» Ms. Murrietta said.
As incidence of the disease rises, the shortage of specialists could start to affect care. In 2011, three U.S. states had no pediatric endocrinologists—doctors who specialize in diseases like diabetes in children—and 22 states had fewer than 10, the study said. That means many cases will likely be handled by the family doctors targeted by the academy’s recommendations.
In a sign of the growing pervasiveness of the diagnosis, the Phoenix Children’s Hospital opened a clinic last fall specifically for youth with the disease. Last year, the hospital diagnosed a record 25 children with Type 2 diabetes and 170 children with Type 1, also a record.