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Diabetes do tipo 2 em crianças

Last reviewed: 21 Aug 2025
Last updated: 24 Apr 2025
24 Apr 2025

Dapagliflozina aprovada pela FDA para o tratamento de diabetes do tipo 2 em crianças

O inibidor da proteína cotransportadora de sódio e glicose 2 (SGTL2) dapagliflozina foi aprovado pela Food and Drug Administration dos EUA (FDA) para melhorar o controle glicêmico em pacientes pediátricos de 10 anos ou mais com diabetes do tipo 2. Antes disso, a dapagliflozina​ tinha sido aprovada apenas para adultos com diabetes do tipo 2 como adjuvante à dieta e exercícios para melhorar o controle glicêmico.

A aprovação em pacientes pediátricos baseou-se nos resultados do T2NOW, um dos maiores ensaios clínicos de fase 3 sobre diabetes do tipo 2 em crianças. Dados demonstraram uma redução significativa na hemoglobina A1c (HbA1c) em pacientes tratados com dapagliflozina, em comparação com os pacientes que receberam placebo. Os resultados de segurança nessa população de pacientes foram consistentes com aqueles em adultos com diabetes do tipo 2.

Dapagliflozina também recebeu aprovação da European Medicines Agency (EMA) para uso em crianças ≥10 anos com diabetes do tipo 2 não controlada, como adjuvante à dieta e exercícios.

See Management: approach

Original source of update

Summary

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • poliúria
  • polidipsia
  • acantose nigricans
  • noctúria
Full details

Other diagnostic factors

  • hipertensão
  • infecções por levedura
  • infecções cutâneas
  • infecções do trato urinário
  • fadiga
  • visão turva
  • perda de peso
Full details

Risk factors

  • obesidade
  • predisposição genética/história familiar
  • origem étnica de alto risco
  • puberdade
  • sexo feminino
  • ambiente diabético intrauterino
  • pequeno para a idade gestacional
  • crescimento rápido na primeira infância
  • alimentação com mamadeira
  • ingestão elevada de proteína na primeira infância
  • ovários policísticos
  • conteúdo lipídico intramiocelular
  • deposição de gordura no fígado
  • dificuldades de aprendizagem
Full details

Diagnostic investigations

1st investigations to order

  • tira reagente para exame de urina
  • glicemia plasmática aleatória
  • glicemia de jejum
  • HbA1c
  • autoanticorpos contra insulina, antígenos de ilhotas 2 (IA-2), descarboxilase do ácido glutâmico (DAG) e transportador de zinco 8 (ZnT8)
Full details

Investigations to consider

  • glicose plasmática de 2 horas
  • peptídeo C aleatório
Full details

Treatment algorithm

ACUTE

cetoacidose ou estado hiperosmolar hiperglicêmico (EHH)

ONGOING

HbA1c <69 mmol/mol: sem acidose ou cetose

HbA1c ≥69 mmol/mol: sem acidose com ou sem cetose

Contributors

Authors

Jennifer Miller, MD
Jennifer Miller

Professor

Department of Pediatrics

University of Florida

Gainesville

FL

Disclosures

JM declares that she has received research funding from Soleno Therapeutics, Harmony Biosciences, and Rhythm Pharmaceuticals. JM is an author of a reference cited in this topic.

Chelsea Zimmerman, MD

Clinical Physician

Pediatric Endocrinology

Endocrinology and Metabolism of East Alabama

Opelika

AL

Disclosures

CZ declares that she has no competing interests.

Acknowledgements

Dr Jennifer Miller and Dr Chelsea Zimmerman would like to gratefully acknowledge Dr Arlan Rosenbloom and Dr Paul Hiers, previous contributors to this topic.

Disclosures

AR is an author of a number of references cited in this topic. Unfortunately, we have since been made aware that AR is deceased. PH declares that he has no competing interests.

Peer reviewers

Philip Zeitler, MD, PhD

Professor of Pediatrics and Clinical Science

University of Colorado School of Medicine

Aurora

CO

Disclosures

PZ declares that he has no competing interests.

Julian P. Hamilton-Shield, MB, ChB, MD(Bristol), MRCP, FRCPCH, FRCPCH

Professor

Diabetes and Metabolic Endocrinology

School of Clinical Sciences

University of Bristol

UK

Disclosures

In the past, JPHS received speaking honoraria from Sanofi-Aventis, Roche, Abbott, Novo-Nordisk, and Nutricia. None of these talks were directly pertinent to the treatment of type 2 diabetes.

Kristen Nadeau, MD

Professor of Pediatric Endocrinology

University of Colorado School of Medicine

Aurora

CO

Disclosures

KN declares that she has no competing interests.

Dennis Styne, MD

Professor of Pediatrics

Rumsey Chair of Pediatric Endocrinology

University of California

Sacramento

CA

Disclosures

DS declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

American Diabetes Association. Standards of care in diabetes - 2025. Diabetes care. 2025 Jan;48(suppl 1):S1-352.Full text

Shah AS, Barrientos-Pérez M, Chang N, et al. ISPAD clinical practice consensus guidelines 2024: type 2 diabetes in children and adolescents. Horm Res Paediatr. 2024;97(6):555-83.Full text  Abstract

Glaser N, Fritsch M, Priyambada L, et al. ISPAD clinical practice consensus guidelines 2022: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2022 Nov;23(7):835-56. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Diabetes do tipo 2 em crianças images
  • Differentials

    • Intolerância à glicose
    • Diabetes mellitus do tipo 1 (DMT1)
    • Diabetes monogênico: diabetes juvenil de início na tardio (MODY)
    More Differentials
  • 指南

    • Type 2 diabetes in children and adolescents
    • Diabetes (type 1 and type 2) in children and young people: diagnosis and management
    More Guidelines
  • 患者教育信息

    Diabetes do tipo 2: devo tomar insulina?

    Diabetes: o que posso fazer para me manter saudável?

    更多 患者教育信息
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