- Describe your topic.
- Diagnosis and Management of Type 2 Diabetes Mellitus in Children and Adolescents Suggested Key Questions: 1. What are the benefits and harms of screening for type 2 diabetes mellitus in children and adolescents? 2. What is the accuracy of diagnostic thresholds for fasting and random blood glucose, glucose tolerance tests, and HbA1c for diagnosing type 2 diabetes mellitus in adolescents? 3. For children and adolescents who have type 2 diabetes mellitus, what are the benefits and harms of available pharmacologic interventions? 4. For children and adolescents who have type 2 diabetes mellitus, what are the benefits and harms of lifestyle and other non-pharmacologic interventions? Population = children/adolescents aged 6 – 18 years of age with type 2 diabetes mellitus Direct outcomes for adolescents: Patient-oriented = morbidity/mortality, quality of life, mental health impact, weight loss, delay/prevention of diabetic complications; disease oriented or intermediate outcomes = blood glucose levels, HbA1c, insulin resistance Long term outcomes (adolescence to adulthood): morbidity/mortality, quality of life, mental health impact, delay/prevention of diabetic complications in adulthood (e.g. retinopathy, nephropathy, atherosclerosis)
- Describe why this topic is important.
- Around 208,000 Americans under age 20 are estimated to have diagnosed diabetes. The incidence of type 2 diabetes increased around 4.8% from 2002 to 2012 (1). Due to the early onset, and therefore longer duration, diabetes in children and adolescents are at risk of developing complications including cardiovascular disease later in life. Around 92 percent of adolescents with type 2 diabetes have more than two cardiovascular risk factors (2,3). The increase risk of complications could lead to decreased quality of life, shortened life expectancy, and increased health care costs. Several groups have provided guidance for care of children and adolescents with type 2 diabetes mellitus, however, the evidence used for the recommendations is now or close to being outdated (4,5). There is agreement that lifestyle modifications should be the first line treatment, however, there is a lack of evidence for clear thresholds for treatment decisions regarding initiation of pharmacologic therapy and limited data on the long-term risk and benefits of commonly used medications. While screening and referral to intensive behavioral interventions is recommended by the USPSTF for children and adolescents who are obese, there is not a recommendation for type 2 diabetes mellitus currently. If treatment goals are not met, most guidelines recommend pharmacologic treatment with insulin or other medication. Metformin is approved by the U.S. Food and Drug Administration (FDA) for use in adolescents, but other medications are being used off-label for this population. An updated review of the evidence for these medications would be beneficial. 1. Mayer-Davis EJ, Lawrence JM, Dabelea D, et al. Incidence trends of type 1 and type 2 diabetes among youths, 2002-2012. NEJM. 2017;376:1419-1429. 2. Rodriguez BL, Fujimoto WY, Mayer-Davis EJ, et al. Prevalence of cardiovascular disease risk factors in U.S. children and adolescents with diabetes: the SEARCH for diabetes in youth study. Diabetes Care. 2006;29(8):1891–1896. 3. Dabelea D, Stafford, JM, Mayer-Davis EJ, et al. Association of type 1 diabetes vs type 2 diabetes diagnosed during childhood and adolescence with complications during teenage years and young adulthood. JAMA. 2017;317(8):825–835. 4. American Academy of Pediatrics. Clinical practice guideline: Management of newly diagnosed type 2 diabetes mellitus (T2DM) in children and adolescents. Pediatrics. 2013; 131(2): 364-382. 5. American Association of Clinical Endocrinologists and American College of Endocrinology. Clinical practice guidelines for developing a diabetes mellitus comprehensive care plan. Endocrine Practice. 2015; 21(S1): 1-87.
- Tell us why you are suggesting this topic.
- The last comprehensive review of the evidence for treatment of type 2 diabetes in children was completed in 2012, therefore there is a need for updated guidance on this topic. As family physicians are dedicated to treating patients across the life span, pediatric issues are an important component to family medicine. Without clear and timely evidence-based guidance, there is a wide spectrum of practice around type 2 diabetes mellitus in children and adolescents.
- Target Date.
- Describe what you are doing currently and what you are hoping will change because of a new evidence report.
- The long-term impact of treating type 2 diabetes mellitus in adolescence has not been established. With the increasing prevalence of diabetes in this age group, it is important to understand the long-term benefits and harms of screening and treatment modalities and the appropriate thresholds to target to prevent or delay complications from diabetes in adulthood. An independent systematic review of available evidence for this topic would provide guidance for appropriate treatment considerations.
- How will you or your group use the information from a new evidence report?
- Develop a clinical practice guideline using a multidisciplinary panel that will include family physicians and other key stakeholders.
- How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?
- Dissemination activities may include one or more of the following: --Publish the guideline in a peer-reviewed journal and make it available online to members and the public. --The guideline will also be shared via news stories, editorials, and social media. --Submit to online database, such as Guidelines International Network and National Guideline Clearinghouse (or its replacement/new iteration)
- Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?
- American Academy of Pediatrics American Diabetes Association Pediatric Endocrine Society Endocrine Society American Association of Endocrinologists
- Information About You: (optional)
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- Provide a description of your role or perspective.
- Medical Society
- If you are you making a suggestion on behalf of an organization, please state the name of the organization.
- American Academy of Family Physicians
- Please tell us how you heard about the Effective Health Care Program.
- The AAFP has a long-standing relationship with AHRQ and the EHC Program.
