The guidelines published by American Academy of Pediatrics emphasize on insulin for the management of type 2 diabetes in children and teenagers aged 10 to 18. All these pediatricians have mostly had to deal with type 1 diabetes, which has a different cause and usually requires different management than type 2 diabetes. But recently due to the rise in childhood obesity, as many as one in three children diagnosed with diabetes has type 2.

Weight doesn't play a role in the development of type 1 diabetes, but it's possible that someone with type 1 could be overweight, making an immediate diagnosis of the type of diabetes very hard. If someone with type 1 diabetes is mistakenly diagnosed with type 2 diabetes, and given oral medications such as metformin instead of the insulin they must have, they can get very sick, very quickly.

That's why the first new guideline is to start a child or teen on insulin if it's at all unclear whether a child has type 1 or type 2 diabetes. The guideline further recommends that they continue using insulin until the diabetes type can be definitively determined.

Other key recommendations include the following:

1. Once a child or teen has been diagnosed with type 2 diabetes, prescribe metformin and lifestyle changes, including nutrition and physical activity.
2. Monitor A1c levels every three months. If treatment goals aren't being met, the physician should make appropriate changes to the treatment regimen.
3. Home monitoring of blood glucose is appropriate for those using insulin, anyone changing their treatment regimen, those who aren't meeting their treatment goals and during times of illness.
4. Physicians should incorporate the Academy of Nutrition and Dietetics' Pediatric Weight Management Evidence-Based Nutrition Practice Guideline in nutrition counseling of children with type 2 diabetes.
5. Children with type 2 diabetes should be encouraged to exercise at least 60 minutes a day and to limit their nonacademic "screen time" (video games, television) to less than two hours a day.