Primary prevention

Prevention of type 2 diabetes mellitus (T2DM) in children involves interventions to prevent the development of obesity or to correct obesity before the development of insulin resistance and comorbidities.[53] Potential dietary targets to prevent overweight in young children include reducing portion sizes of snacks and meals in preschool settings and reducing intakes of protein and sugar-sweetened beverages.[54]​ Sales of sugary drinks have fallen greatly in high income countries over the past two decades, with larger reductions in countries that introduced fiscal policies, such as the UK’s soft drinks industry levy.[54]​ Behavior-changing interventions that incorporate diet and physical activity may be beneficial in achieving small, short-term reductions in body mass index.[55]​

World Health Organisation (WHO) guidelines advise that higher dietary fiber intake is associated with reduced risk of developing T2DM.[56]​ They recommend that carbohydrate intake should come primarily from high fiber foods (i.e., whole grains, vegetables, fruits, and pulses); this is based on evidence (predominantly from studies in adults) that higher intakes of these substances are associated with reduced risk of T2DM.[56]​ The following daily intakes of vegetables/fruits and naturally occurring dietary fiber (as consumed in foods) are recommended:[56]

  • 2-5 years old: at least 250 g of vegetables and fruits, at least 15 g of naturally occurring dietary fiber

  • 6-9 years old: at least 350 g of vegetables and fruits, at least 21 g of naturally occurring dietary fiber

  • 10 years or older: at least 400 g of vegetables and fruits, at least 25 g of naturally occurring dietary fiber

It is recognized that age of diagnosis is inversely associated with increased morbidity and mortality from T2DM; thus, strategies are needed to better identify at-risk children who could benefit from follow-up and early intervention to slow or stop progression to T2DM.[57]​ There are differences between populations as to how predictive impaired glucose tolerance (IGT) is for the development of T2DM. In Europe, IGT is not seen as highly predictive of progression to diabetes in the short-to-medium term.[58] However, in those with black African ancestry, IGT is seen as more predictive of developing diabetes.[59] Intensive lifestyle modifications, including 5% to 10% weight loss, are recommended for these children to prevent the development of T2DM.

There is debate surrounding the role of metformin in T2DM prevention in children; long-term data are limited in the pediatric population and further research is needed.[57][60][61]​​​​

Secondary prevention

Identification and targeting of lifestyle modifications for children at risk for the development of T2DM can delay the onset of disease.[121]

Early identification and aggressive treatment of complications such as inadequate glycemic control, hypertension, dyslipidemia, and albuminuria may reduce premature morbidity and mortality.

Diabetes education and lifestyle modifications for the entire family, and not just the patient, may be beneficial in increasing compliance and preventing long-term complications.

Smoking cessation counseling for older children and adolescents should be included as a routine component of diabetes care, to prevent long-term cardiovascular complications. Note that vaping and electronic cigarettes are also discouraged.[1]​ As alcohol use has implications for glycemic management and safety in young people with diabetes, patients should be educated about the risks and advised to reduce alcohol use if appropriate. All patients should be advised not to use cannabis recreationally in any form.[1]​

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