Summary

• A progressive disorder due to a deficit in both insulin secretion and insulin action, with obesity being the primary cause in children.
• Often asymptomatic and diagnosed by screening in a high-risk individual (e.g., family history, obesity, acanthosis nigricans) or incidentally (e.g., glycosuria found after a school or sports examination).
• The development of insulin resistance and glucose intolerance can be prevented by lifestyle modifications that correct obesity in children.
• Goals of treatment are to promote weight loss and exercise capacity, decrease acanthosis nigricans, normalise glycaemia and HbA1c (goal is <53 mmol/mol [7%]), and prevent long-term complications (e.g., hypertension and dyslipidaemia).
• Treatment includes lifestyle modifications, metformin, and insulin.