For pediatric patients with type 2 diabetes, metformin and insulin continue to be the mainstay of treatment, study authors concluded in a review published in Annals of Pharmacotherapy.

Jennifer D. Smith, PharmD, and colleagues from Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC, reviewed the current literature for the efficacy and safety of available treatment for pediatric type 2 diabetes. They conducted a search from January 1990–April 2016 and extracted relevant articles and preliminary clinical trial data on metformin, insulin, sulfonylureas, thiazolidinediones (TZDs), glucagon-like peptide-1 (GLP-1) receptor agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors, and alpha-glucosidase inhibitors for the treatment of pediatric type 2 diabetes. 

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The study authors found that metformin (as studied in 4 trials) and premixed insulin appeared to be safe and effective for pediatric patients with type 2 diabetes. Also, TZDs were well tolerated and resulted in favorable outcomes but “may have limited applicability”; incretin-based agents also showed favorable outcomes but with limited safety and efficacy data. A sulfonylurea produced favorable HbA1c reduction but was also linked with significant weight increase.

Dr. Smith added that other agents were studied in several trials with unpublished results but no statistical analyses were reported. In general, more conclusive studies are needed to help with evidence-based guidance for the treatment of type 2 diabetes in the pediatric population.

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