Type 2 diabetes mellitus in children and adolescents.

Abstract

1. J. Darrell Nesmith, MD, MPH* 1. 2. *Assistant Professor of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR. Objectives After completing this article, readers should be able to: 1. Delineate the population in which type 2 diabetes mellitus is reaching epidemic proportions. 2. List the characteristics of type 2 diabetes mellitus. 3. Explain the increasing prevalence of type 2 diabetes mellitus among children. 4. Characterize the clinical and laboratory features as well as the course of the disease that will assist in classification of the patient who has diabetes mellitus. 5. Describe the treatments for type 2 diabetes mellitus. Type 2 diabetes mellitus (DM) is a common disease affecting more than 15 million Americans. Its prevalence among adults is increasing, but more worrisome is the recent recognition of type 2 DM among children and adolescents. Little is known about the etiology, management, and changing epidemiology of this disease in pediatric populations. Nonetheless, practitioners who care for children and adolescents must consider the diagnosis of type 2 DM in the child presenting with hyperglycemia. The diagnostic criteria and etiologic classification of DM are listed in Tables 1⇓ and 2⇓ . The diagnosis of DM is based on blood glucose measurements that may be obtained randomly, in the fasting state, or during an oral glucose tolerance test. The fasting blood glucose test is easy and inexpensive to perform and is recommended for screening by the American Diabetes Association (ADA). The criteria for making the diagnosis of DM were changed in 1997 by the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus to propose simple and sensitive screening tests for carbohydrate metabolism derangements. View this table: Table 1. Criteria for the Diagnosis of Diabetes Mellitus (DM)1 View this table: Table 2. Etiologic Classification of Diabetes Mellitus (DM)1 DM represents a group of diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Type 1 DM is due to insulin deficiency usually caused by autoimmune destruction of …