Type 2 Diabetes Mellitus in Children and Adolescents

Kavitha Dileepan; M. Max Feldt

doi:10.1542/pir.34-12-541

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Kavitha Dileepan, MD, MPH*
M. Max Feldt, DO^†

^*Department of Pediatrics, University of Missouri Kansas City School of Medicine, Children's Mercy Hospital Kansas City, MO. Dr Dileepan was a pediatric endocrinology fellow at Children’s Mercy Hospital, Kansas City, MO, at the time this article was authored.
^†Department of Pediatrics, University of Missouri Kansas City School of Medicine, Children’s Mercy Hospital, Kansas City, MO.

Author Disclosure
Drs Dileepan and Feldt have disclosed no financial relationships relevant to this article. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

ADA:: American Diabetes Association
DM:: diabetes mellitus
FDA:: Food and Drug Administration
GAD:: glutamic decarboxylase
HbA1c:: hemoglobin A1c
OGTT:: oral glucose tolerance test
TODAY:: Treatment Options for Type 2 Diabetes in Adolescents and Youth

Educational Gaps

The growing pandemic of childhood obesity has led to marked increases in the incidence and prevalence of type 2 diabetes mellitus (DM) and has further complicated the differentiation between type 2 and type 1 DM because more children with type 1 DM are overweight at time of diagnosis. In addition, numerous studies have demonstrated β-cell autoimmunity in children with type 2 DM. (1)

Objectives

After completing this article, readers should be able to:

Differentiate between and understand the treatment of type 2 diabetes mellitus (DM) and type 1 DM by recognizing underlying pathophysiologic characteristics, clinical features, and laboratory markers.
Recognize the difficulty in distinguishing between type 2 and type 1 DM because of the increasing prevalence of childhood obesity.
Understand the increased prevalence of type 2 DM in children and adolescents, especially among certain racial/ethnic groups.
Recognize risk factors, appropriate screening, and diagnosis of type 2 DM, and understand the appropriate treatment for type 2 DM in the pediatric population.
Recognize the comorbidities and complications associated with type 2 DM in children and adolescents and understand that these may be present at the time of diagnosis.

Introduction

Type 2 diabetes mellitus (DM), historically considered a serious chronic medical condition only for older individuals, now has an increased prevalence in children and adolescents. The estimated overall incidence of type 2 DM is 22 cases per 100,000 youth or approximately 3600 youth diagnosed with the condition each year. (2) From a public health perspective, DM is the seventh leading cause of death in the United States, a figure that is likely underestimated. (3) The total cost to treat DM in both adults and …