Type 2 diabetes in children

Last reviewed: June 2019

Last updated: March 2019

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

Treatment includes lifestyle modifications, metformin, and insulin.

Definition

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 or greater (126 mg/dL or greater) on 2 separate occasions, a random plasma glucose of 11.1 mmol/L or greater (200 mg/dL or greater) with symptoms of polyuria or polydipsia, a plasma glucose level of 11.1 mmol/L or greater (200 mg/dL or greater) 2 hours after ingestion of glucose during an oral glucose tolerance test, or haemoglobin A1c 48 mmol/mol (6.5%) or greater. In the absence of unequivocal hyperglycaemia, the test must be repeated to substantiate the diagnosis. [1]

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

History and exam

Key diagnostic factors

presence of risk factors
acanthosis nigricans
polyuria
polydipsia
nocturia

Full details

Other diagnostic factors

hypertension
yeast infections
skin infections
urinary tract infections
fatigue
blurred vision
weight loss

Full details

Risk factors

obesity
genetic predisposition/family history
high-risk ethnic background
puberty
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

Full details

Diagnostic investigations

1st investigations to order

urine dipstick
random plasma glucose
fasting plasma glucose
HbA1c
autoantibodies to insulin, islet cell, glutamic acid decarboxylase, and zinc transporter 8

Full details

Investigations to consider

oral glucose tolerance test
C-peptide

Full details

Treatment algorithm

ACUTE

ketosis

severe hyperglycaemia: newly diagnosed

ONGOING

HbA1c 53 mmol/mol to 86 mmol/mol (7% to 10%)

HbA1c over 86 mmol/mol (>10%)

Contributors

Authors VIEW ALL 

Paul Hiers, MD

Pediatric Endocrinology Fellow

Department of Pediatrics

University of Florida

Gainesville

Disclosures

PH declares that he has no competing interests.

Jennifer Miller, MD

Assistant Professor

Department of Pediatrics

University of Florida

Gainesville

Disclosures

JM is an author of a reference cited in this topic.

Acknowledgements

Dr Paul Hiers and Dr Jennifer Miller wish to gratefully acknowledge Dr Arlan Rosenbloom, a previous contributor to this topic.

Peer reviewers VIEW ALL 

Julian P. Hamilton-Shield, MB, ChB, MD(Bristol), MRCP, FRCPCH, FRCPCH

Professor

Diabetes and Metabolic Endocrinology

School of Clinical Sciences

University of Bristol

Disclosures

In the past, JPHS received speaking honoraria from Sanofi-Aventis, Roche, Abbott, Novo-Nordisk, and Nutricia. None of these talks were directly pertinent to the treatment of type 2 diabetes.

Kristen Nadeau, MD

Professor of Pediatrics

University of California

Sacramento

Disclosures

KN declares that she has no competing interests.

Dennis Styne, MD

Professor of Pediatrics

Rumsey Chair of Pediatric Endocrinology

University of California

Sacramento

Disclosures

DS declares that he has no competing interests.

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Type 2 diabetes in children

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

ketosis

severe hyperglycaemia: newly diagnosed

HbA1c 53 mmol/mol to 86 mmol/mol (7% to 10%)

HbA1c over 86 mmol/mol (>10%)

Contributors

Authors VIEW ALL 

Paul Hiers, MD

Disclosures

Jennifer Miller, MD

Disclosures

Acknowledgements

Peer reviewers VIEW ALL 

Julian P. Hamilton-Shield, MB, ChB, MD(Bristol), MRCP, FRCPCH, FRCPCH

Disclosures

Kristen Nadeau, MD

Disclosures

Dennis Styne, MD

Disclosures

Differentials

Guidelines

Patient leaflets

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