Treatment of type 2 diabetes in children: what are the specific considerations?

ABSTRACT

Introduction: The number of individuals under 18 years of age with type 2 diabetes is increasing at an alarming rate worldwide. These patients are often characterized by obesity and they often experience a more rapid disease progression than adults with type 2 diabetes. Thus, focus on prevention and management of complications and comorbidities is imperative. With emphasis on weight loss and optimal glycemic control, treatment includes lifestyle changes and pharmacotherapy, which in this patient group is limited to metformin, liraglutide and insulin. In selected cases, bariatric surgery is indicated.

Areas covered: This perspective article provides an overview of the literature covering pathophysiology, diagnosis, characteristics and treatment of pediatric type 2 diabetes, and outlines the gaps in our knowledge where further research is needed. The paper draws on both mechanistic studies, large scale intervention trials, epidemiological studies and international consensus statements.

Expert opinion: Type 2 diabetes in pediatric patients is an increasing health care problem, and the current treatment strategies do not successfully meet the many challenges and obstacles in this patient group. Treatments must be early, intensive, multifaceted and durable. Also, prevention of obesity and type 2 diabetes in at-risk children should be addressed and prioritized on all levels.

KEYWORDS:

• Adolescents
• children
• insulin
• liraglutide
• metformin
• obesity
• pediatric
• type 2 diabetes

Article highlights

• An alarming increase in the incidence and prevalence of type 2 diabetes in individuals under 18 years of age is accompanying the ongoing obesity pandemic

• Most of these patients develop type 2 diabetes during puberty and they often have a more rapid disease progression with earlier need for treatment intensification than adults

• Comorbidities arise early and frequently

• Treatment should focus on behavioral change, glycemic control, weight loss and prevention of comorbidities and complications

• Pharmacological treatment options are limited compared to adult type 2 diabetes; the biguanide metformin, the glucagon-like peptide 1 receptor agonist liraglutide and insulin are the only approved pharmacotherapies

• Better and more effective preventive measures need to be implemented in order to mitigate the rising incidence and prevalence of type 2 diabetes among children and adolescents

• Screening in at-risk individuals and relevant treatment focusing on prevention of comorbidities and complications should be an important public health priority

Declaration of interest

MFG Grondahl is a minority shareholder in the pharmaceutical company Zealand Pharma A/S. FK Knop, over the past five years, has served on the scientific advisory boards and/or been part of the speaker’s bureaus for, served as a consultant to and/or received research support from Amgen Inc, AstraZeneca, Bayer, Boehringer Ingelheim, Carmot Therapeutics, Eli Lilly and Company, Gubra, Lupin, MedImmune, Merck Sharp and Dohme, Mundipharma, Norgine, Novo Nordisk, Pharmacosmos, Sanofi and Zealand Pharma. He is also a minority shareholder in Antag Therapeutics Aps. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.