The rapid emergence of childhood T2DM poses challenges to the physician who is unequipped to treat adult diseases en- countered in children. Most diabetes training and educational materials designed for pediatric patients address type 1 diabetes mellitus (T1DM) and em- phasize insulin treatment and glucose
PEDIATRICS Volume 131, Number 2, February 2013
monitoring, which may or may not be appropriate for children with T2DM.7,8 Most medications used for T2DM have been tested for safety and efficacy only in individuals older than 18 years, and there is scant scientific evidence for optimal management of children with T2DM.9,10 Extrapolation of data from adult studies to pediatric populations may not be valid because the hormonal milieu of the prepubescent and pubes- cent patient with T2DM can affect treatment goals and modalities in ways heretofore unencountered in adult patients.11
The United States has a severe shortage of pediatric endocrinologists, making access to these specialists difficult or, in some cases, impossible.12 Vast geo- graphic areas lack a pediatric endo- crinologist: in 2011, 3 states had no pediatric endocrinologists, and 22 had fewer than 10, and the situation is un- likely to improve in the near future.13 In 2004, the National Association of Child- ren’s Hospitals and Related Institutions performed a workforce survey and found that patients had to wait almost 9 weeks for an appointment to see an endocrinologist.14 Because the number of patients with T1DM and T2DM has increased since then, this situation is presumably worse today. Regardless of their age, most patients in the United States who have T2DM are cared for by primary care providers (PCPs).15
The rapid emergence of childhood T2DM poses challenges to the physician who is unequipped to treat adult diseases en- countered in children. Most diabetes training and educational materials designed for pediatric patients address type 1 diabetes mellitus (T1DM) and em- phasize insulin treatment and glucose
PEDIATRICS Volume 131, Number 2, February 2013
monitoring, which may or may not be appropriate for children with T2DM.7,8 Most medications used for T2DM have been tested for safety and efficacy only in individuals older than 18 years, and there is scant scientific evidence for optimal management of children with T2DM.9,10 Extrapolation of data from adult studies to pediatric populations may not be valid because the hormonal milieu of the prepubescent and pubes- cent patient with T2DM can affect treatment goals and modalities in ways heretofore unencountered in adult patients.11
The United States has a severe shortage of pediatric endocrinologists, making access to these specialists difficult or, in some cases, impossible.12 Vast geo- graphic areas lack a pediatric endo- crinologist: in 2011, 3 states had no pediatric endocrinologists, and 22 had fewer than 10, and the situation is un- likely to improve in the near future.13 In 2004, the National Association of Child- ren’s Hospitals and Related Institutions performed a workforce survey and found that patients had to wait almost 9 weeks for an appointment to see an endocrinologist.14 Because the number of patients with T1DM and T2DM has increased since then, this situation is presumably worse today. Regardless of their age, most patients in the United States who have T2DM are cared for by primary care providers (PCPs).15
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