Type 2 Diabetes in Children and Adolescents - The Next Epidemic?

Eva M. Vivian


Curr Med Res Opin. 2006;22(2):297-306. 

In This Article

Screening and Diagnosis

The American Diabetes Association and the American Academy of Pediatrics recommends diabetes screening for children over 10 years of age (or at onset of puberty if earlier) with a BMI above the 85th percentile who have any two of the following risk factors: a first or second degree relative with diabetes; belong to a high risk race/ ethnic group; or display signs of insulin resistance such as acanthosis nigricans, hypertension, polycystic ovarian syndrome (PCOS), or dyslipidemia ( Table 1 ).[28]

The fasting plasma glucose test is the preferred diagnostic test, although the oral glucose tolerance test (OGTT), or random postprandial blood glucose level can also be used to confirm diabetes. There are currently no established diagnosis criteria for children. The American Diabetes Association criteria for diagnosis in adults have been extrapolated to children and adolescents ( Table 2 ). The caveat is that many children have lower mean glucose levels, and, as a result, the criteria used for diagnosis in adults may not be low enough to detect hyperglycemia in children.[28]

Previously, the majority of cases of diabetes in the pediatric population have been type 1. However, the increasing incidence of type 2 diabetes in this population presents a challenge to the clinician, who must be able to distinguish between type 1 and type 2 diabetes in children in order to select appropriate pharmacologic therapy. Patients with type 1 diabetes are typically under or normal weight and present with weight-loss, polyuria, polydipsia, and ketosis. Due to the increasing rise of obesity in the US, approximately 24% of type 1 patients with diabetes may be overweight at the time of diagnosis. In contrast, most children with type 2 diabetes are obese at the time of diagnosis.[28]

Typically, children with type 2 diabetes are members of a high-risk group with a family history of type 2 diabetes. Over 50% of children with type 2 diabetes have one parent with the same condition and a family history of diabetes over generations.[28] Only 5% of children with type 1 diabetes have a first-or second-degree relative with type 1 diabetes.[28]

Type 1 diabetes is the result of a chronic immune-mediated destruction of beta-cells. Antibodies to autoantigens, glutamic acid decarboxylase, insulin, and tyrosine dehydrogenase are typically present in patients with type 1 diabetes but low or absent in patients with type 2 diabetes. Generally, C-peptide levels are normal or elevated in patients with type 2 diabetes, but may be low at the time of diagnosis due to the effects of glucose toxicity on the beta-cells. Conversely, C-peptide levels in type 1 diabetes are normally low, but may be normal during the 'honeymoon' phase.[28] Therefore, C-peptide levels can be measured at the time of diagnosis, but should be rechecked 1 year after diagnosis in patients whose classification is uncertain.[29,30] In addition, glucose toxicity may result in decreased beta-cell function, resulting in ketoacidosis in up to 50% of children with type 2 diabetes. This overlap in clinical features presents a diagnostic challenge for clinicians who must be able to correctly distinguish between type 1 and type 2 diabetes in children to manage the condition effectively.


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