Type 2 diabetes mellitus in children and adolescents

Table 4 Treatment option of type 2 diabetes mellitus in children and adolescents [Federal Drug Administration (United States), European Medicine Evaluation Agency (European)]

Modality	Glycaemiareduction	Enhance insulin secretion	Insulin resistancelowering	FDA/EMEA approved for children	Notes
Diet and exercise	Yes	No	Yes	Yes	First-line approach
					Efficacy depends on successful ife-style change
Insulin	Yes	No	No	Yes	Weight gain discussed
					risk of hypoglycemia
Metformin	Yes	No	Yes	Yes	Good safety record
					minimal weight loss
Sulphonylureas	Yes	Yes	No	No	Good safety record in adults
					risk of hypoglycemia
Meglitinide analogues	Yes	Yes	No	No	Sparse data on their use
Thiazolidinediones	Yes	?	Yes	No	Weight gain
					lack of long-term data
Dipeptidyl peptidase inhibitors (DPP4)/ glucagon like peptide (GLP) 1 mimetics	Yes	No	No	No	Moderate weight loss
					Carcinoma of the pancreas discussed
					Lack of long-term data
Sodium-Glucose Cotransporter 2 Inhibitors	Yes	No	No	No	Minimal weight loss
					Urinary and genital tract infections
					Risk of hypoglycaemia
					Sparse data on their use
					Lack of long-term data
Acarbose	?	No	No	No	Side effects may be unacceptable
Orlistat	?	No	No	No	Side effects may be unacceptable
Surgical treatment of obesity	Yes	No	Yes	No	Some anecdotal evidence

?: Unknown; FDA: Federal Drug Administration; EMEA: European Medicine Evaluation Agency.