Type 2 diabetes in children

Type 2 diabetes is 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 haemoglobin A1c (goal is <53 mmol/mol [7%]), and prevent long-term complications (e.g., hypertension and dyslipidaemia).

Initial treatment includes lifestyle modifications, metformin, and insulin. Liraglutide is approved in some countries as an additional non-insulin treatment option for children aged ≥10 years. 

Type 2 diabetes mellitus is a progressive disorder due to a deficit in both insulin secretion and insulin action leading to abnormal glucose metabolism and related metabolic derangements.

Diagnosis is based on a fasting plasma glucose of ≥7 mmol/L (≥126 mg/dL), a random plasma glucose of ≥11.1 mmol/L (≥200 mg/dL) with symptoms of polyuria or polydipsia, a plasma glucose level of ≥11.1 mmol/L (≥200 mg/dL) 2 hours after ingestion of glucose during an oral glucose tolerance test, or haemoglobin A1c ≥48 mmol/mol (6.5%). In the absence of unequivocal hyperglycaemia, the test must be repeated to substantiate the diagnosis.[1]American Diabetes Association. Standards of medical care in diabetes - 2021. Diabetes Care. 2021; 44(suppl 1):S1-S232. 

Obesity, leading to insulin resistance, is the primary cause in children.