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Screening, assessment and management of type 2 diabetes mellitus in children and adolescents: Australasian Paediatric Endocrine Group guidelines

Alexia S Peña, Jacqueline A Curran, Michelle Fuery, Catherine George, Craig A Jefferies, Kristine Lobley, Karissa Ludwig, Ann M Maguire, Emily Papadimos, Aimee Peters, Fiona Sellars, Jane Speight, Angela Titmuss, Dyanne Wilson, Jencia Wong, Caroline Worth and Rachana Dahiya
Med J Aust 2020; 213 (1): . || doi: 10.5694/mja2.50666
Published online: 6 July 2020

Abstract

Introduction: The incidence of type 2 diabetes mellitus has increased in children and adolescents due largely to the obesity epidemic, particularly in high risk ethnic groups. β‐Cell function declines faster and diabetes complications develop earlier in paediatric type 2 diabetes compared with adult‐onset type 2 diabetes. There are no consensus guidelines in Australasia for assessment and management of type 2 diabetes in paediatric populations and health professionals have had to refer to adult guidelines. Recent international paediatric guidelines did not address adaptations to care for patients from Indigenous backgrounds.

Main recommendations: This guideline provides advice on paediatric type 2 diabetes in relation to screening, diagnosis, diabetes education, monitoring including targets, multicomponent healthy lifestyle, pharmacotherapy, assessment and management of complications and comorbidities, and transition. There is also a dedicated section on considerations of care for children and adolescents from Indigenous background in Australia and New Zealand.

Changes in management as a result of the guidelines: Published international guidelines currently exist, but the challenges and specifics to care for children and adolescents with type 2 diabetes which should apply to Australasia have not been addressed to date. These include:

  • recommendations regarding care of children and adolescents from Indigenous backgrounds in Australia and New Zealand including screening and management;
  • tighter diabetes targets (glycated haemoglobin, ≤ 48 mmol/mol [≤ 6.5%]) for all children and adolescents;
  • considering the use of newer medications approved for adults with type 2 diabetes under the guidance of a paediatric endocrinologist; and
  • the need to transition adolescents with type 2 diabetes to a diabetes multidisciplinary care team including an adult endocrinologist for their ongoing care.
  • Alexia S Peña1,2
  • Jacqueline A Curran3
  • Michelle Fuery4
  • Catherine George3
  • Craig A Jefferies5
  • Kristine Lobley6
  • Karissa Ludwig7
  • Ann M Maguire6,8
  • Emily Papadimos4,9
  • Aimee Peters6
  • Fiona Sellars4
  • Jane Speight10,11
  • Angela Titmuss9,12
  • Dyanne Wilson13
  • Jencia Wong8,14
  • Caroline Worth5
  • Rachana Dahiya4,15

  • 1 Robinson Research Institute, University of Adelaide, Adelaide, SA
  • 2 Women's and Children's Hospital, Adelaide, SA
  • 3 Perth Children's Hospital, Perth, WA
  • 4 Queensland Children's Hospital, Brisbane, QLD
  • 5 Starship Children's Health, Auckland, New Zealand
  • 6 Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW
  • 7 Sydney Children's Hospital, Randwick, Sydney, NSW
  • 8 University of Sydney, Sydney, NSW
  • 9 Menzies School of Health Research, Darwin, NT
  • 10 Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC
  • 11 Deakin University, Geelong, VIC
  • 12 Royal Darwin Hospital, Darwin, NT
  • 13 Cairns Hospital, Cairns, QLD
  • 14 Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW
  • 15 University of Queensland, Brisbane, QLD

Correspondence: alexia.pena@adelaide.edu.au

Acknowledgements: 

We thank the Australasian Paediatric Endocrine Group (APEG) for facilitating the creation of the guideline‐developing group, teleconference and meetings required for producing this manuscript. We also thank APEG, the New Zealand Society for the Study of Diabetes, and the Australian Diabetes Educators Association for reviewing and providing comments to the manuscript before endorsement.

Competing interests:

No relevant disclosures.

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