Diabetes in Children: Time to Treat Like Little Adults?

I know, I know.  I know what you're wondering.  What's a geriatrician doing writing about pediatrics?  Let's not forget that first & foremost, I'm a family physician, so my training (albeit decades ago) included care of little people.  Except that back then, it was pounded into my thick skull that children are not little adults and should not be treated as such.  In fact, they have their own needs & idiosyncrasies.  Funny!  I think I hear myself saying the same thing except substituting "elderly" for "children".

In any case, I digress because just yesterday, the American Academy of Pediatrics released their Clinical Practice Guideline regarding the management of newly diagnosed diabetes type 2 in children & adolescents (a rarity back in the day).  The full text of their new guideline is now available in their Pediatrics journal.  What's different in this new guideline and sets it apart from previous guidelines is the willingness, nay, recommendation to offer the biguanide, metformin, to lifestyle modification after making an initial diagnosis of type 2 diabetes in children & adolescents.  The irony is that we've been taking the same approach for adults for several years now, as updated in this month's Diabetes Care.  

Unfortunately, beyond insulin, most of the other pharmacologic options available for use in adults have not been approved by the Food & Drug Administration for use in children & adolescents.  Bottom line: we need to really focus on lifestyle modification in both the young, middle-age & elderly.  If not, we're dooming them to a lifetime of medications.

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