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 during a school or sports exam).
The development of insulin resistance and glucose intolerance can be prevented or delayed by lifestyle modifications that correct obesity in children.
Goals of treatment are to promote weight loss and exercise capacity, decrease acanthosis nigricans, normalize glycemia and hemoglobin A1c (goal is <7%), and prevent long-term complications and comorbidities (e.g., retinopathy, hypertension, and dyslipidemia).
Initial treatment includes lifestyle modifications, metformin, and insulin. Glucagon-like peptide-1 (GLP-1) receptor agonists are approved in some countries as an additional non-insulin treatment option for children ages ≥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 ≥126 mg/dL (≥7.0 mmol/L), a random plasma glucose of ≥200 mg/dL (≥11.1 mmol/L) with symptoms of hyperglycemia (e.g., polyuria or polydipsia) or hyperglycemic crisis, a plasma glucose level of ≥200 mg/dL (≥11.1 mmol/L) 2 hours after 75 g oral glucose, or hemoglobin A1c of ≥6.5% (≥48 mmol/mol). In the absence of unequivocal hyperglycemia, the diagnosis requires two abnormal test results from the same sample, or in two separate test samples.
Obesity, leading to insulin resistance, is the primary cause in children.
History and exam
Key diagnostic factors
- acanthosis nigricans
Other diagnostic factors
- yeast infections
- skin infections
- urinary tract infections
- blurred vision
- weight loss
- genetic predisposition/family history
- African-American, Hispanic, American-Indian, and Asian or Pacific Islander
- female sex
- small for gestational age
- rapid growth in infancy
- diabetic in-utero environment
- bottle feeding
- high protein intake in infancy
- polycystic ovaries
- intramyocellular lipid content
- fat deposition in the liver
1st investigations to order
- urine dipstick
- random plasma glucose
- fasting plasma glucose
- autoantibodies to insulin, islet cells, islet antigens, glutamic acid decarboxylase, and zinc transporter 8
Investigations to consider
- 2-hour plasma glucose
- random C-peptide
ketoacidosis or hyperosmolar hyperglycemic nonketotic syndrome
HbA1c <8.5%: no acidosis or ketosis
HbA1c ≥8.5%: no acidosis with or without ketosis
- Impaired glucose tolerance
- Type 1 diabetes mellitus (T1DM)
- Monogenic diabetes: maturity-onset diabetes of the young
- Standards of care in diabetes
- Type 2 diabetes in children and adolescents
Diabetes type 2: should I take insulin?
Diabetes type 2: what treatments work?More Patient leaflets
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