Type 2 Diabetes Mellitus in Childhood and Adolescence.

Abstract

1. Dorit Koren, MD, MTR* 2. Lynne L. Levitsky, MD* 1. *Division of Pediatric Endocrinology and Pediatric Diabetes Center, Department of Pediatrics, Massachusetts General Hospital, Boston, MA * Abbreviations: ADA: : American Diabetes Association DKA: : diabetic ketoacidosis FDA: : Food and Drug Administration FPG: : fasting plasma glucose HbA1c: : glycohemoglobin IR: : insulin resistance LGA: : large for gestational age MODY: : maturity-onset diabetes of youth NAFLD: : nonalcoholic fatty liver disease RISE: : Restoring Insulin Secretion SES: : socioeconomic status SGA: : small for gestational age T1D: : type 1 diabetes mellitus T2D: : type 2 diabetes mellitus TODAY: : Treatment Options for Type 2 Diabetes in Adolescents and Youth The incidence and prevalence of type 2 diabetes mellitus (T2D) are increasing in children and adolescents as a result of the worldwide pediatric obesity epidemic. It is important to distinguish type 1 diabetes mellitus, which is more common in children, from T2D because clinical phenotypes may overlap at presentation, but clinical course and treatment options differ considerably. Thus, it is crucial to diagnose this disease early and to choose appropriate treatment. In addition, prevention of T2D by directly addressing and preventing or ameliorating excess weight gain in young people is of great importance in primary care. After completing this article, readers should be able to: 1. Describe the pathophysiology and risk factors for type 2 diabetes mellitus (T2D) in children and adolescents. 2. Explain that there may be an overlap in the presentation between type 1 diabetes mellitus (T1D) and T2D: children with T1D may be overweight or obese, and children with T2D may present with ketosis or ketoacidosis. 3. Screen appropriate childhood populations for T2D. 4. Recognize that individuals with youth-onset T2D are at higher risk for diabetes-related complications than those with T1D and adults with T2D and, therefore, require careful longitudinal follow-up and treatment. The pediatric obesity pandemic of the past few decades has been accompanied by an increase in the incidence and prevalence of type 2 diabetes mellitus (T2D) in childhood, with a disproportionate disease burden in children of minority ethnic groups and low socioeconomic status (SES). (1) Childhood-onset T2D is associated with greater …