Guidance for the Clinician in Rendering Pediatric Care

The emergence of type 2 diabetes mellitus in the American Indian/Alaska Native pediatric population presents a new challenge for pediatricians and other health care professionals. This chronic disease requires preventive efforts, early diagnosis, and collaborative care of the patient and family within the context of a medical home. Pediatrics 2003;112:e328–e347. URL: http://www. pediatrics.org/cgi/content/full/112/4/e328; type 2 diabetes mellitus, children, American Indian, Alaska Native, Native American, pediatric population. ABBREVIATIONS. AI/AN, American Indian/Alaska Native; AAP, American Academy of Pediatrics; IHS, Indian Health Service; CDC, Centers for Disease Control and Prevention; ADA, American Diabetes Association; PCOS, polycystic ovarian syndrome; BMI, body mass index; HbA1c, glycosylated hemoglobin; OGTT, oral glucose tolerance test; FBG, fasting blood glucose; FPG, fasting plasma glucose; SMBG, self-monitoring of blood glucose; ACE, angiotensin-converting enzyme; LDL, low-density lipoprotein; HDL, high-density lipoprotein; NDEP, National Diabetes Education Program; NPH, neutral protamine Hagedorn; TZD, thiazolidinedione. STATEMENT OF THE PROBLEM Type 2 diabetes mellitus* is a new morbidity in children and adolescents.1–4 For pediatric patients, it heralds earlier onset of cardiovascular disease, retinopathy, nephropathy, and neuropathy, with risk of impaired quality of life and premature death. The emergence of type 2 diabetes mellitus in young people is believed to be associated with changes in physical activity and nutrition that are ubiquitous in modern society. Not all populations are equally affected. American Indian/Alaska Native (AI/AN) children in the United States and Canada have a higher rate of this disease than do children of other ethnicities. Mexican American and black children are at increased risk. Vulnerable populations that exhibit new disease trends may be seen as the “canary in the coal mine,” warning of hazards present for the entire population. In US children, the prevalence of type 2 diabetes mellitus is expected to exceed that of type 1 diabetes mellitus within 10 years. There is a compelling need for additional research, primary and secondary prevention efforts, and evidence-based treatment for youth with type 2 diabetes mellitus.