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Chapter 3: Type 2 Diabetes mellitus in youth

Chapter 3: Type 2 Diabetes mellitus in youth
Phil Zeitler, Silva Arslanian, Junfen Fu, Orit Pinhas-Hamiel, Thomas Reinehr, Nikhil Tandon, Tatsuhiko Urakami, Jencia Wong, David M Maahs


Chapter highlights:

The 2018 guidelines more fully take into account the findings of the TODAY study, SEARCH for Diabetes in Youth, and the Pediatric Diabetes Consortium. Most importantly, the guidelines align closely with the first-ever ADA Statement on the Evaluation and Management of Type 2 Diabetes in Youth which was recently finalized and will be published in Diabetes Care. This alignment was facilitated by the addition of Silva Arslanian as Co-author; Drs. Zeitler and Arslanian are co-chairs of the ADA Statement. 


Major changes include:

  • Additional information regarding the assessment of monogenic diabetes in patients with presumed type 2 diabetes
  • Increase in the hemoglobin A1c target to 7% to align with the ADA.  In specific circumstances, a lower target is reasonable, given the low incidence of hypoglycemia in adolescents.
  • Update of oral hypoglycemic agents
  • Change in the recommendation for management of increased albumin excretion to be more evidence-based and to align with the ADA adult and pediatric type 2 recommendations.  This includes the recommendation to treat microalbuminuria only in the presence of elevated BP with the target or reducing BP to normal, rather than to normalization of urinary albumin excretion
  •  Expansion of recommendations regarding the diagnosis and evaluation of non-alcoholic fatty liver disease



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