Prognosis
Assess the family's motivation and desire for lifestyle changes and encourage the family to play an active role in the management of the child's diabetes. Effective treatment requires a motivated and informed family who are willing to engage in lifestyle modifications that involve the entire family, not just the affected child. The parents or carers must be willing to take responsibility for the monitoring and care of the child's diabetes, and the child must be motivated to lose weight and take drugs regularly. Review the patient every 3 months, monitor glycaemic control and compliance, assess lifestyle modifications, and adjust drug regimens as necessary to achieve optimal glycaemic control.
Long-term
Over two-thirds of adolescents with overweight will develop obesity as adults.[23] The lifetime risk of end-stage complications of diabetes are currently not known for children. In adults, the risks are estimated to be 5% for renal disease, <5% for blindness, and 8% for amputations. Studies are needed to assess adherence to drug treatment in the paediatric population, as non-concordance with drug regimen and failure to meet treatment goals is likely to have a significant impact on the prevalence of complications as these children age.[106] Success rates for adequate treatment of children with type 2 diabetes mellitus (T2DM) vary, but overall, long-term successful management of this population is likely to prove difficult given high rates of drop-out from medical care and poor attainment of the goals of lifestyle interventions.[107] A UK audit found that only 36% of those with T2DM aged 12 years and over received all of their six essential health checks (for haemoglobin A1c [HbA1c], body mass index, blood pressure, cholesterol, albuminuria, and feet) in 2021/2022. This was nearly half the rate of those with type 1 diabetes of the same age (63.4%).[26]
It is recognised that age of diagnosis is inversely associated with increased morbidity and mortality from T2DM.[60] The TODAY study found that higher baseline HbA1c concentration and fasting glucose variability during the first year after diagnosis accurately predict youth with T2DM who will experience metabolic decompensation and comorbidities.[108]
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