Youth-Onset Type 2 Diabetes Mellitus In Primary Practice

A Review

Kimberly Egan Gonzalez, MSN, PNP; Wyona Freysteinson, PhD, MN

Disclosures

Pediatr Nurs. 2019;45(6):293-296, 288. 

In This Article

Abstract and Introduction

Abstract

Background: Youth-onset type 2 diabetes mellitus is alarmingly on the rise. A diagnosis of type 2 diabetes at a young age leads to complications and a potential shortened lifespan.

Purpose: To provide the primary care provider with evidence-based findings of youth-onset type 2 diabetes mellitus, including signs and symptoms, screening protocols and risk factors, complications and comorbidities to monitor, and management goals.

Methods: A literature review was completed using the CINAHL, Medline, and PubMed databases with the key terms type 2 diabetes mellitus, adolescents, risk factors, complications, and treatment. Limits included articles written in English and published between 2013–2019.

Findings: Adolescents are diagnosed with type 2 diabetes mellitus at the onset of puberty or around the age of 10 years, and the numbers are increasing. The diagnosis is more aggressive in this age group leading to complications much quicker than when diagnosed later in life.

Conclusion: It is important for primary care practitioners to be aware of the risk factors and to screen this age group even if asymptomatic. Early treatment and continued evaluation for diabetes-related complications are necessary for control of symptoms and reversal of the disease. Further research on the prevention of type 2 diabetes mellitus in this age group is indicated.

Introduction

Youth-onset type 2 diabetes mellitus, previously known as non-insulin dependent diabetes, is a disorder of insulin resistance that has mainly affected the adult population (Unnikrishnan, Shah, & Mohan, 2016). Type 2 diabetes mellitus has been perceived as a milder form of diabetes and considered a disease of lifestyle with an easier treatment plan and a better prognosis (Wong, Constantino, & Yue, 2015). Youth-onset type 2 diabetes mellitus occurs during puberty as plasma insulin levels rise from pre-pubertal baseline levels then peak during puberty (Wong et al., 2015). There is a marked difference between adult-onset and youth-onset type 2 diabetes mellitus. The adult population takes years for hyperglycemia to progress, while it occurs more rapidly in youth with an aggressive time course, leading to significant risks for diabetes-related complications (Amutha & Mohan, 2016; Unnikrishnan et al., 2016). The purpose of this review is to provide signs and symptoms, screening protocols according to the American Diabetes Association (ADA) (2019), complications to monitor, management, and implications for primary care providers who care for youth in the 10- to 19-year age range. Suggestions for future research are included.

Articles reviewed were primary research articles or from the two primary studies: Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) and the SEARCH study for Diabetes in Youth. The TODAY study was the largest population of youth and adolescents with type 2 diabetes mellitus to date. A total of 699 subjects from institutions across the country participated. Enrollment was from 2004–2009. Participants were followed for 2 to 6 years with the primary outcome to treatment failure. Eligibility included a diagnosis of type 2 diabetes mellitus within the previous two years, 10 to 17 years of age, ability to speak and read English, and a willing family member. Participants were randomly assigned into one of three treatment groups: 1) Metformin alone; 2) Metformin plus Rosiglitazone; or 3) Metformin plus an intensive lifestyle program that incorporated nutrition, physical activity, and behavior modification. The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institute of Health (TODAY, n.d.).

The SEARCH (2019) study for Diabetes in Youth is a national multi-center study with an aim to understand more about children and young adults diagnosed with diabetes in the United States. There are study centers in five states (South Carolina, Ohio, Colorado, California, and Washington), with some having various center locations throughout the state. The population includes over 20,000 participants from different racial and ethnic backgrounds. The study launched in the year 2000 with plans to continue through the year 2020. The study is funded by the Centers for Disease Control and Prevention (CDC) and the NIDDK.

Youth-onset type 2 diabetes mellitus is characterized as a chronic and progressive disease that is associated with a higher prevalence of comorbidities and follows a more aggressive path than seen in the adult population. Symptoms have become more prevalent in the younger age group (10 to 19 years), and particularly in some ethnic groups (Afkarian, 2015; Unnikrishnan et al., 2016). The prevalence of this diagnosis in this age group is estimated to have increased by over 30% between 2001–2009 (Dabelea et al., 2014). A disproportionate rise in diagnosis is higher in females than males, in lower socioeconomic status, and among certain racial and ethnic minorities. The authors do not expand on the gender disproportion (Dabelea et al., 2014; Pettitt et al., 2014). The disease is more aggressive than adult-onset diabetes, more difficult to initially diagnose, has a high rate of comorbidities, and has limited treatment options (Hannon & Arslanian, 2015).

The rising rate of obesity is linked to an increasing rate of youth-onset type 2 diabetes mellitus. Obesity in this population is a result of lifestyle habits, an increase in caloric intake, a decrease in physical activity, and an increase in sedentary behaviors, which leads to a surplus of energy that the body stores as fat (Arslanian et al., 2018). The National Center for Health Statistics indicates the trends of childhood obesity increased from 13.9% in 1999–2000 to 18.5% in 2015–2016 (Hales, Carroll, Fryar, & Ogden, 2017). The highest rate of obesity was 20.6% in the adolescent age group (12 to 19 years) followed by 18.4% in the youth age group (6 to 11 years). In 2015–2016, youth Hispanic males showed the highest rate of obesity (28%), followed by non-Hispanic white females (25.1%) and Hispanic females (23.6%). This increase in obesity in children and adolescents leads to health complications, such as type 2 diabetes mellitus. Overweight children as young as 2 years had a higher inflammatory score, increased lipid profile numbers, and insulin resistance as an adolescent (Oliveira-Santos et al., 2019).

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