Prognosis
The physician must assess the family's motivation and desire for lifestyle changes and must 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 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 medications regularly. The physician should review the patient every 3 months, monitor glycemic control and compliance, assess the lifestyle modifications, and adjust medication regimens as necessary to achieve optimal glycemic control.
Long-term
Over two-thirds of adolescents with overweight will develop obesity as adults.[26] 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 medication adherence in the pediatric population, as noncompliance with medication regimen and failure to meet treatment goals is likely to have a significant impact on the prevalence of these complications as these children age.[92] Success rates for adequate treatment of children with type 2 diabetes mellitus 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.[93]
Early identification and treatment of comorbidities of hypertension, dyslipidemia, and inadequate glycemic control may reduce the risk of premature morbidity and mortality of major cardiovascular complications by >50%.
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