The article titled “A review of the Treatment of type 2 diabetes in children” addresses the available evidence-based pediatric diabetes type 2 treatments. It is a research paper authored by Erin Onge, Miller Shannon, Motycka Carol, and DeBerry Adrienne and published in 2015 in the Journal of Pediatric Pharmacology and Therapeutics. The article provides a diabetes type 2 treatment overview and a clinical review and trial data on pediatric pharmacological treatment for children with diabetes type 2.
Discussion and Summary of Research Findings
Diabetes type 2 incidences among children are on the rise, and a high percentage of children with diabetes type 2 are obese. Prior research on diabetes type 2 treatments has revealed that the use of oral medication in children is more challenging than it is to adults (Erin, Miller, Motycka and DeBerry, 2015). Most of the diabetes type 2 medication has not been studied at a pediatric level since diabetes type 2 is more prevalent to adults than children.
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To address the existing gap in diabetes type 2 treatments among children, the Pediatric Endocrine Society and the American Diabetes Association collaborated to develop a guideline for pediatric diabetes type 2 treatment. In the case of adults, metformin is the dominant or mainstream treatment alongside exercise and diet ( Newton, Hou, Crimmins, Lavine, Barlow, Xanthakos & Schwimmer, 2016) . To avoid macrovascular and microvascular complication among the children with diabetes type 2 due to the use of mainstream treatments, adjunctive therapy that is based on clinical evidence and patient preference was thus necessary.
Epidemiological research statistics on diabetes type 2 among children indicate that it has globally increased over the last two decades with the greatest incidences noted among the non-white children. The pathophysiology of diabetes type 2 is initiated by the progressive imbalance in the blood glucose homeostasis resulting in impaired secretion of insulin from the β-cells of the pancreas (Erin, Miller, Motycka and DeBerry, 2015). Obesity in children leads to the onset of insulin resistance in the body, which ultimately leads to diabetes type 2.
Diagnosis of diabetes type 2 in children is often late complications are noted. However, diabetes type 2 diagnosis among children is more focused on the concentration of blood glucose as well as other symptoms like weight loss, polydipsia, and polyuria ( Newton et al., 2016) . Children with a high BMI with a diabetes family history and possible signs of insulin resistance are more likely to suffer diabetes type 2 and thus should be screened for early detection.
The study established that treatment for diabetes type 2 needs to be focused on decreasing children complication. Despite the fact that there are few studies on diabetes type 2 in children, data from studies on children with diabetes type 1 and adults with diabetes type 2 indicate that treatment that improves on glycemic control reduces on the risk of microvascular complications.
Clinical Findings
Clinical evidence supports the fact that all children with diabetes type 2 start a metformin treatment. Clinically, metformin decreases the production of hepatic glucose and stimulates the uptake of glucose in the peripheral body tissues. Metformin is effective when administered to children between the ages of 10 to 16 years (Erin, Miller, Motycka and DeBerry, 2015). The administration dosage starts at only 500 mg a day for at least two weeks and then increased to reach the target dosage of 2000 mg per day. The only common adverse effect of metformin to children can include gastrointestinal upset, diarrhea, and abdominal pain.
In a clinical trial, 82 children of the age 10-16 years with diabetes type 2 were randomized and administered with metformin or a placebo. The children were administered the tolerable metformin dosage but not exceeding 2000 mg per day. It was observed that there was a significant reduction on the FPG on the group on metformin and an increase on the group on placebo (−42.9 mg/dL vs. +21.4 mg/dL, p<0.001) (Erin, Miller, Motycka and DeBerry, 2015). Further findings noted that the mean concentration (A1c) reduced from 8.2% to 7.5% on the group on metformin while the group on a placebo slightly reduced from 8.9% to 8.6%.
Other metabolic effects results noted in the clinical trial include a decrease in the mean cholesterol serum on the group on metformin (−9.7 mg/dL) while the group on a placebo experienced a slight increase in mean cholesterol serum (0.7 mg/dL) (Erin, Miller, Motycka and DeBerry, 2015). The group on metformin noted a great loss in BMI with a mean change baseline of −1.5 kg while the group under a placebo noted a −0.9 kg BMI mean change. There was also some adverse effects noted among the group under metformin, and it included instances of headache, vomiting, nausea, diarrhea, and abdominal pain, although these effects did not necessitate discontinuity of treatment.
The Relevance of Research in Nursing Practice
This research provides the nursing fraternity with an evidence-based understanding of the best treatment for children with diabetes type 2. The study findings were based on past studies, and clinical trials provide nurses with relevant pediatric diabetes type 2 treatment options which ensures better patients outcome with minimum adverse effects. From the study administration of metformin up to 2000 mg offers a better treatment option to children with diabetes type 2. The research findings offer nurses with a complete understanding on how metformin impacts on children’s FPG (fasting plasma glucose), the A1c (hemoglobin A1c), cholesterol serum and BMI (Body Mass Index). The research also provides nurses with the possible adverse effects metformin have on children but which are not severe to necessitate stop of administration.
References
Erin, O., Miller, S., Motycka, C, and DeBerry, A. (2015). A review of the Treatment of type 2 diabetes in children. Journal of Pediatric Pharmacology and Therapeutics , 20(1): 4–16. doi: 10.5863/1551-6776-20.1.4
Newton, K. P., Hou, J., Crimmins, N. A., Lavine, J. E., Barlow, S. E., Xanthakos, S. A. & Schwimmer, J. B. (2016). Prevalence of prediabetes and type 2 diabetes in children with nonalcoholic fatty liver disease. JAMA Pediatrics , 170 (10), e161971-e161971.
