Hi Folks:

I'm interested in those that might be working with children and adolescents that have type 2 diabetes.  What if any standards of care are you using? 
Have any of you seen the

ISPAD Clinical Practice Consensus Guidelines 2009 Compendium?

http://www.ispad.org/

I'm not familiary with this group as I'm doing more ADULT. 

I've done a lit search, but only tuned up the AAP document that was written in 2003, and reaffirmed in 2009.

Hi Joan
The American Diabetes Assn has outlined clinical guidelines for children with Type 2 Diabetes. They appear in Diabetes Care Volume 33, Supplement 1 (2010). I will outline a few of them for you:

Screening for children should begin at age 10 or puberty if it occurs earlier and repeated every 3 years for children who are overweight (BMI>85th percentile for age & sex,  weight for height >85th percentile or weight >120% of ideal for height) and have2 of the following risk factors:
 *family history of type 2 diabetes in 1st or 2nd degree relative
*Race, ehnicity: African American,Latino,Asizn American, Pacific Islander
*Signs of insulin resistance,e.g. acanthosis nigricans,hypertension, dyslipidemia,polycystic ovarian syndrome or smaller fo rgestational age birthweight
*Maternal history of diabetes or gestational diabetes during child's gestation
*Puberty (due to growth hormone and insulin like growth factor)

Blood glucose targets are higher in children from birth to age 19 because the goal is prevention of hypoglycemia that can cause serious brain damage:
Age less than 6.....A1c 7.5 to8.5%......Before meals:100-180mg/dl......bedtime/overnight: 110-200
Age 6 to 12.............A1c <8%..............Before meals: 100-180mg/dl....bedtime/overnight:100-180
Age 13 to 19..........A1c <7.5%...............Before meals:90-130mg/dl.......bedtime/overnight 90-150
over age 19....adult levels as goal is prevention of complications caused by hyperglycemia
I always hasten to add when teaching health professionals and families that there is a low to high range.  The high range for glycemic targets in children is only to prevent brain damage from hypoglycemia. If hypoglycemia is not a problem (especially less frequent with type 2 diabetes) then the targets can be on the lower end of the range

There are also stated goals for screening and treatment for cholesterol, nephropathy,hypertension and retinopathy.
Here are some sad statistics from  Med IQ 2007: Comorbidities for children and adolescents at the time of diagnosis of type 2 diabetes:

Hi Pat:
Thanks for the review of the ADbA material. I'd seen their info, and was looking for something a little more in detail.  Which lead me to the other 2 groups.  I am surprised with type 2 in children on the rise that that population doesn't get their own supplement.  Thanks again for the referenced material.

I just wanted to point out a type in Pat's excellent summary of the ADA standards of care for children with Type 2 diabetes.  In children age 6 to 12 years, an A1c of < 8% is recommended, not 8.5%.  Joan, do you have any pediatric endo colleagues who could get a copy of the newest recommendations from ISPAC? 

Thanks, Donna.....you are a fabulous colleague!
I corrected it.

Pediatric Diabetes 2009: 10(Suppl. 12): 17–32

doi: 10.1111/j.1399-5448.2009.00584.x

I was able to get a copy on line.....