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.
Obesity, leading to insulin resistance, is the primary cause in children.
History and exam
Key diagnostic factors
- presence of risk factors
- acanthosis nigricans
Other diagnostic factors
- yeast infections
- skin infections
- urinary tract infections
- blurred vision
- weight loss
- genetic predisposition/family history
- high-risk ethnic background
- female sex
- small for gestation age
- rapid growth in infancy
- diabetic in-utero environment
- bottle feeding
- high protein intake in infancy
- polycystic ovaries
- intra-myocellular lipid content
- fat deposition in the liver
1st investigations to order
- urine dipstick
- random plasma glucose
- fasting plasma glucose
- autoantibodies to insulin, islet cell, glutamic acid decarboxylase, and zinc transporter 8
Investigations to consider
- oral glucose tolerance test
severe hyperglycaemia: newly diagnosed
HbA1c 53-86 mmol/mol (7% to 10%)
HbA1c >86 mmol/mol (>10%)
- Glucose intolerance
- Type 1 diabetes mellitus (T1DM)
- Monogenic diabetes
- Diabetes (type 1 and type 2) in children and young people: diagnosis and management
- Type 2 diabetes in adults: management
Diabetes: what is it?
Diabetes type 2: what treatments work?More Patient leaflets
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