Type 2 diabetes in children

Type 2 diabetes in children usually presents after the onset of puberty, at a mean age of 14 years, with obesity being the primary cause.

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, normalize glycemia and hemoglobin A1c (goal is <6.5% [<48 mmol/mol]), 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 and sodium-glucose cotransporter-2 (SGLT2) inhibitors 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 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).[1]American Diabetes Association. Standards of care in diabetes - 2025. Diabetes care. 2025 Jan;48(suppl 1):S1-352. https://diabetesjournals.org/care/issue/48/Supplement_1 ​​ In the absence of unequivocal hyperglycemia, the diagnosis requires two abnormal test results from the same sample, or in two separate test samples.​​[1]American Diabetes Association. Standards of care in diabetes - 2025. Diabetes care. 2025 Jan;48(suppl 1):S1-352. https://diabetesjournals.org/care/issue/48/Supplement_1

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