Treatment of type 2 diabetes mellitus in children and adolescents

The treatment of type 2 diabetes mellitus (DM) is directed at decreasing in sulin resistance and increasing insulin secretion. alpha -Glucosidase inhib itors slow carbohydrate absorption, resulting in reduced postprandial hyper glycemia; thiazolidinediones increase insulin sensitivity, especially in mu scle and adipocytes; metformin decreases hepatic gluconeogenesis; sulfonylu reas result in prolonged increases in insulin secretion; and meglitinide ca uses rapid, short-lived increases in insulin secretion, A survey of 130 ped iatric endocrinology practices in the USA and Canada indicated that 48% of children with type 2 DM were treated with insulin and 44% with one or more oral hypoglycemic agents (OHA). Of those treated with OHA, 71% received met formin, 46% sulfonylureas, 9% thiazolidinediones and 4% meglitinide, Simila rly, in the three university-based diabetes centers in Florida, 50% of the children with type 2 DM were treated with OHA. Treatment is based on sympto ms at presentation. Patients identified on routine testing are often treate d with exercise and diet alone. Those who are mildly symptomatic at onset a re often started on OHA, Patients with substantial ketosis, ketoacidosis or markedly elevated blood glucose levels are initially treated with insulin, followed by a tapering of the dose and the addition of an OHA after blood glucose control is established and symptoms subside. There are no studies o f the efficacy or compliance with treatment for type 2 DM in adolescents. T reatment is currently based on the clinical experience with adults. Control led clinical trials in children are essential.