Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- acanthosis nigricans
- polyuria
- polydipsia
- nocturia
Other diagnostic factors
- hypertension
- yeast infections
- skin infections
- urinary tract infections
- fatigue
- blurred vision
- weight loss
Risk factors
- obesity
- genetic predisposition/family history
- high-risk ethnic background
- puberty
- 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
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
Investigations to consider
- oral glucose tolerance test
- C-peptide
Treatment algorithm
ketosis
severe hyperglycaemia: newly diagnosed
HbA1c 53-86 mmol/mol (7% to 10%)
HbA1c >86 mmol/mol (>10%)
Contributors
Authors
Paul Hiers, MD
Pediatric Endocrinology Fellow
Department of Pediatrics
University of Florida
Gainesville
FL
Disclosures
PH declares that he has no competing interests.
Jennifer Miller, MD

Assistant Professor
Department of Pediatrics
University of Florida
Gainesville
FL
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.
Disclosures
AR is an author of a number of references cited in this topic.
Peer reviewers
Julian P. Hamilton-Shield, MB, ChB, MD(Bristol), MRCP, FRCPCH, FRCPCH
Professor
Diabetes and Metabolic Endocrinology
School of Clinical Sciences
University of Bristol
UK
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
CA
Disclosures
KN declares that she has no competing interests.
Dennis Styne, MD
Professor of Pediatrics
Rumsey Chair of Pediatric Endocrinology
University of California
Sacramento
CA
Disclosures
DS declares that he has no competing interests.
Differentials
- Glucose intolerance
- Type 1 diabetes mellitus (T1DM)
- Monogenic diabetes
More DifferentialsGuidelines
- Type 2 diabetes in adults: management
- Obesity: identification, assessment and management
More GuidelinesPatient leaflets
Diabetes: what is it?
Diabetes type 2: what treatments work?
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