Options for managing type 2 diabetes in children
Overview
Liraglutide (Victoza) is the first new non-insulin medication approved to treat type 2 diabetes in children in almost 20 years. Children often don't get enough from metformin (Glucophage) alone since they have less insulin secretion and more insulin resistance at diagnosis. Plus kids may not stick with insulin because of weight gain. Victoza and other GLP-1 agonists can be "insulin sparing" and promote weight loss in adults with diabetes. But it's too soon to say if this is the case with Victoza in kids with type 2 diabetes.
Stepwise Approach to Pediatric Diabetes Management
Achieving glycemic control in children with diabetes requires a comprehensive plan. This includes personalized insulin therapy, regular glucose checks, and dietary planning, alongside monitoring HbA1c levels and screening for complications to support healthy growth.
- Promote lifestyle changes:
- For example, suggest the 5-2-1-0 approach: 5 or more fruits and veggies, no more than 2 hours of screen time, at least 1 hour of physical activity, and 0 sugary drinks with plenty of water daily.
- Start with metformin for most kids with type 2 diabetes. It's weight-neutral, affordable, and has a proven safety record. Evaluate adding injectable Victoza or insulin based on pros and cons.
- For children aged 10 and older, adding Victoza to metformin (with or without insulin) can lower A1C by about 0.6% over 6 months.
- Consider Victoza for those close to their A1C target and seeking to limit weight gain from insulin. Note, however, that Victoza is costly.
- Start at 0.6 mg/day and increase to 1.8 mg/day gradually to reduce nausea and vomiting.
- Consider adding insulin if A1C goals aren’t met. For some children, a single daily dose of insulin (e.g., glargine or NPH) may be effective.
- Explain that evidence for other diabetes medications in children is limited. Aim for an A1C below 7%, but individualize goals based on each child’s needs.
- For further guidance, see "Management of Diabetes Mellitus in Primary Care" and "Pharmacotherapy of Type 2 Diabetes".
References
- Tamborlane WV, Barrientos-Pérez M, Fainberg U, et al. Liraglutide in Children and Adolescents with Type 2 Diabetes. N Engl J Med. 2019;381(7):637-646.
- Zeitler P, Arslanian S, Fu J, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Type 2 diabetes mellitus in youth. Pediatr Diabetes. 2018;19 Suppl 27:28-46.
- Arslanian S, Bacha F, Grey M, Marcus MD, White NH, Zeitler P. Evaluation and Management of Youth-Onset Type 2 Diabetes: A Position Statement by the American Diabetes Association. Diabetes Care. 2018;41(12):2648-2668.
