Type 2 diabetes in youth is increasing today due to increasing obesity and the sedentary lifestyle of many of today's youth. It can be difficult to diagnose because the individual may present with clinical symptoms similar to type 1 diabetes. Treatment protocols are in a process of being established and may vary based on the clinical symptomatology, psychosocial and cultural factors and growth and development needs of the child/adolescent.

Recent evidence suggests that children and adolescents are developing an unusual form of diabetes associated with obesity. This type of diabetes differs from type 1 diabetes where the body stops producing insulin. Type 2 diabetes in youth is essentially a problem with insulin resistance. Reasons to know more about this condition include:

Identification of the disease in order to detect and treat those at risk and impact early diagnosis.

Recognition of the disease as an emerging health issue and concern by the National Institutes of Health, Center for Disease Control, American Diabetes Association, and the American Academy of Pediatrics.

What is Type 2 Diabetes in Youth? It is a complex, chronic, metabolic disorder characterized by insulin resistance syndrome. It is often associated with hypertension, dyslipidemia and obesity. The etiology is multiple and includes genetic, environmental, and socio-cultural risk factors.

Who Might Be Affected

  • Youth with BMI greater than 85th percentile for age and sex

  • Youth with sedentary lifestyle

  • Youth with family history of type 2 diabetes

  • Youth primarily between 8-19 years of age

  • Youth with Acanthosis Nigricans: darkened, thick, velvety pigmentation in skin folds

  • Most commonly found in American Indian, African American, Hispanic/Latino, and Asian/South Pacific Islanders, but also occurs in Caucasians

  • Females have a greater incidence than males

How is Type 2 in Youth Diagnosed?

Diagnosis is usually based on the clinical picture at presentation and American Diabetes Association diagnostic criteria. It may be difficult to diagnose and may even initially resemble type 1 diabetes, with ketoacidosis or ketonuria.

Diagnosis of Type 2 in Youth*
Fasting Glucose >126 mg/dl
Non fasting (casual) plasma glucose >200 mg/dl with symptoms of diabetes: polyuria, polydipsia and unexplained weight loss
Two hour Plasma Glucose >200 mg/dl during a standard OGTT

* Each test must be confirmed on a subsequent day,
by any of the three methods above

The patient outcome goals are to decrease insulin resistance and to prevent and delay the complications associated with diabetes. This should be accomplished through:

  • Near normalization of blood glucose and glycohemoglobin

  • Normalization of blood pressure if hypertension exists

  • Controlling lipids if abnormalities present

Treatment Approaches

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  • Interdisciplinary team approach to care which may include physician, social worker, psychologist, registered dietitian, registered nurse educator and exercise physiologist.

  • Individualized patient and family self-management education, nutritional counseling, and physical activity based on the growth and development needs of the child/adolescent.

  • Regular visits to appropriate health care providers for evaluation and follow-up.

  • Medication usage: insulin or oral medications may be prescribed.

  • Routine health tests and exams including: dilated eye exam, foot exams, blood pressure, lipids, and albuminuria.

Help with lifestyle modifications is one of the most important and challenging issues for the health care provider. Ongoing support and reinforcement of self-management teaching, and review of treatments will assist the patient to meet outcome goals.

References

  • American Diabetes Association, Type 2 Diabetes in Children and Adolescents, Pediatrics, Volume 105, No. 3, March, 2000. www.diabetes.org/ada/type2kids.asp
  • Fagot-Campagna, Anne, MD, Ph.D. et al., Type 2 Diabetes Among North American Children and Adolescents: An epidemiologic review and a public health perspective, Journal of Pediatrics, May 2000, Volume 136, Number 5, Pg 664-672.
  • Henry, Douglas, MD, Non-Type 1 Diabetes in Children and Adolescents, Mediguide to Diabetes, Bayer Corporation, Volume 5, Issue 2.

MDCH