A practical evidence-based approach to management of type 2 diabetes in children and young people (CYP): UK consensus

• Published in: BMC medicine 2024-04, Vol.22 (1), p.144-17, Article 144
• Main Authors: White, Billy, Ng, S M, Agwu, J C, Barrett, T G, Birchmore, N, Kershaw, M, Drew, J, Kavvoura, F, Law, J, Moudiotis, C, Procter, E, Paul, P, Regan, F, Reilly, P, Sachdev, P, Sakremath, R, Semple, C, Sharples, K, Skae, M, Timmis, A, Williams, E, Wright, N, Soni, A
• Format: Article
• Language: English
• Subjects: Adipose tissue; Adolescent; Adult; Adults; Antibodies; Antidiabetics; Bariatric surgery; Carbohydrates; Cardiovascular diseases; Care and treatment; Child; Children; Children & youth; Children and young people; Comorbidity; Complications and side effects; Complications of excess weight; Demographic aspects; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - therapy; Diagnosis; Dietitians; Dosage and administration; Dyslipidemia; Eating behavior; Exercise; Glucose monitoring; Guideline; Health aspects; Health risks; Humans; Hypertension; Insulin resistance; Life style; Lifestyles; Metformin; Microvasculature; Morbidity; Mortality; Obesity; Obesity in children; Observational studies; Pediatrics; Physical activity; Practice guidelines (Medicine); Primary care; Psychologists; Quality; Reagents; Reduction; Signs and symptoms; Social workers; Teams; Type 2 diabetes; United Kingdom - epidemiology; Young adults
• ISSN: 1741-7015; 1741-7015
• DOI: 10.1186/s12916-024-03349-4

Type 2 diabetes in young people is an aggressive disease with a greater risk of complications leading to increased morbidity and mortality during the most productive years of life. Prevalence in the UK and globally is rising yet experience in managing this condition is limited. There are no consensus guidelines in the UK for the assessment and management of paediatric type 2 diabetes. Multidisciplinary professionals from The Association of Children's Diabetes Clinicians (ACDC) and the National Type 2 Diabetes Working Group reviewed the evidence base and made recommendations using the Grading Of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Young people with type 2 diabetes should be managed within a paediatric diabetes team with close working with adult diabetes specialists, primary care and other paediatric specialties. Diagnosis of diabetes type can be challenging with many overlapping features. Diabetes antibodies may be needed to aid diagnosis. Co-morbidities and complications are frequently present at diagnosis and should be managed holistically. Lifestyle change and metformin are the mainstay of early treatment, with some needing additional basal insulin. GLP1 agonists should be used as second-line agents once early ketosis and symptoms are controlled. Glycaemic control improves microvascular but not cardiovascular risk. Reduction in excess adiposity, smoking prevention, increased physical activity and reduction of hypertension and dyslipidaemia are essential to reduce major adverse cardiovascular events. This evidence-based guideline aims to provide a practical approach in managing this condition in the UK.