Abstract
The prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents is on the rise, and the increase in prevalence of this disorder parallels the modern epidemic of childhood obesity worldwide. T2DM affects primarily post-pubertal adolescents from ethnic/racial minorities and those from socioeconomically disadvantaged backgrounds. Youth with T2DM often have additional cardiovascular risk factors at diagnosis. T2DM in youth is more progressive in comparison to adult onset T2DM and shows lower rates of response to pharmacotherapy and more rapid development of diabetes-related complications. Lifestyle modifications and metformin are recommended as the first-line treatment for youth with T2DM in the absence of significant hyperglycemia. Assessment of pancreatic autoimmunity is recommended in all youth who appear to have T2DM. Pharmacotherapeutic options for youth with T2DM are limited at this time. Liraglutide, a GLP-1 agonist, was recently approved for T2DM in adolescents 10 years of age and older. Several clinical trials are currently underway with youth with T2DM with medications that are approved for T2DM in adults. Bariatric surgery is associated with excellent rates of remission of T2DM in adolescents with severe obesity and should be considered in selected adolescents.
Highlights
The prevalence of childhood obesity is increasing globally, both in the developing and developed nations [1]
Liraglutide is a GLP-1 analog that was approved by the Food and Drug Administration (FDA) and European Medicines Agency (EMA) in 2019 for children ≥10 years and adolescents with type 2 diabetes mellitus (T2DM)
TZDs are not recommended for treatment of T2DM in youth, as the use of this class of medications was subsequently restricted by the FDA due to cardiovascular concerns with rosiglitazone [47], bladder cancer concerns with pioglitazone [48], and increased fracture risk concerns with both [49]
Summary
The prevalence of childhood obesity is increasing globally, both in the developing and developed nations [1]. In the SEARCH for Diabetes in Youth study in the United States, the unadjusted incidence rate of T2DM increased from 9.0 cases per 100,000 in 2002–2003 to 12.5 cases per 100,000 in 2011–2012 [3]. The SEARCH study reported that the prevalence of T2DM in youth (defined as
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