Treatment of pediatric type 2 diabetes

<p> <strong> Objective: </strong> To review the current literature for the efficacy and safety of available treatments for type 2 diabetes (T2DM) in the pediatric population.</p><p> <strong> Data Sources: </strong> A search from January 1990 to April 2016 was conducted using PubMed and <a href="http://clinicaltrials.gov/" target="_blank"> clinicaltrials.gov </a> using the search terms <em> diabetes mellitus, type 2; adolescent; child </em> ; and <em> pediatric </em> . Bibliographies of chosen articles were reviewed.</p><p> <strong> S </strong> <strong> tudy Selection and Data Extraction: </strong> Relevant articles and preliminary data from clinical trials on metformin, insulin, sulfonylureas, thiazolidinediones (TZDs), glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, and &alpha;-glucosidase inhibitors for the treatment of pediatric T2DM were reviewed. Studies included randomized controlled, observational, and open-label designs.</p><p> <strong> Data Synthesis: </strong> Metformin, studied in 4 of the reviewed trials, and premixed insulin appear to be safe and effective in pediatric patients with T2DM. TZDs were well tolerated and yielded favorable results, but may have limited applicability. A sulfonylurea had favorable hemoglobin A _1C reduction, but was associated with significant weight gain. Studies of incretin-based agents also showed favorable results in the pediatric population but have limited safety and efficacy data. Several trials for other agents are reported on <a href="http://clinicaltrials.gov/" target="_blank"> clinicaltrials.gov </a> with unpublished results, but no statistical analyses are reported.</p><p> <strong> Conclusion: </strong> Metformin and insulin remain the mainstay of treatment for T2DM in pediatric patients. More robust studies are needed to assist in the provision of evidence-based guidance for the treatment of T2DM in youth.</p>