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Type 2 diabetes in children

Last reviewed: 30 Oct 2023
Last updated: 28 Nov 2023



History and exam

Key diagnostic factors

  • acanthosis nigricans
  • polyuria
  • polydipsia
  • nocturia
More key diagnostic factors

Other diagnostic factors

  • hypertension
  • yeast infections
  • skin infections
  • urinary tract infections
  • fatigue
  • blurred vision
  • weight loss
Other diagnostic factors

Risk factors

  • obesity
  • genetic predisposition/family history
  • African-American, Hispanic, American-Indian, and Asian or Pacific Islander
  • puberty
  • 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
More risk factors

Diagnostic investigations

1st investigations to order

  • urine dipstick
  • random plasma glucose
  • fasting plasma glucose
  • HbA1c
  • autoantibodies to insulin, islet cells, islet antigens, glutamic acid decarboxylase, and zinc transporter 8
More 1st investigations to order

Investigations to consider

  • 2-hour plasma glucose
  • random C-peptide
More investigations to consider

Treatment algorithm


ketoacidosis or hyperosmolar hyperglycemic nonketotic syndrome


HbA1c <8.5%: no acidosis or ketosis

HbA1c ≥8.5%: no acidosis with or without ketosis



Jennifer Miller, MD
Jennifer Miller

Assistant Professor

Department of Pediatrics

University of Florida




JM declares that she has received research funding from Soleno Therapeutics, Harmony Pharmaceuticals, Tryp Therapeutics, and Rhythm Pharmaceuticals. JM is an author of a reference cited in this topic.

Chelsea Zimmerman, MD

Clinical Physician

Pediatric Endocrinology

Endocrinology and Metabolism of East Alabama




CZ declares that she has no competing interests.


Dr Jennifer Miller and Dr Chelsea Zimmerman would like to gratefully acknowledge Dr Arlan Rosenbloom and Dr Paul Hiers, previous contributors to this topic.


AR is an author of a number of references cited in this topic. PH declares that he has no competing interests.

Peer reviewers

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


Diabetes and Metabolic Endocrinology

School of Clinical Sciences

University of Bristol



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




KN declares that she has no competing interests.

Dennis Styne, MD

Professor of Pediatrics

Rumsey Chair of Pediatric Endocrinology

University of California




DS declares that he has no competing interests.

  • Type 2 diabetes in children images
  • Differentials

    • Impaired glucose tolerance
    • Type 1 diabetes mellitus (T1DM)
    • Monogenic diabetes: maturity-onset diabetes of the young
    More Differentials
  • Guidelines

    • Standards of care in diabetes
    • Type 2 diabetes in children and adolescents​
    More Guidelines
  • Patient leaflets

    Diabetes type 2: should I take insulin?

    Diabetes type 2: what treatments work?

    More Patient leaflets
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