ISPAD Clinical Practice Consensus Guidelines 2022: Type 2 diabetes in children and adolescents

Abstract

Since the 2018 ISPAD guidelines on this topic, follow-up of large cohorts from around the globe have continued informing the current incidence and prevalence of co-morbidities and complications in young adults with youth-onset type 2 diabetes (T2D). This chapter focuses on the risk factors, diagnosis and presentation of youthonset T2D, the initial and subsequent management of youth-onset T2D, and management of co-morbidities and complications. We include key updates from the observational phase of the multi-center Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial, the SEARCH for Diabetes in Youth (SEARCH) study and new data from the Restoring Insulin Secretion (RISE) study, a head-to-head comparison of youth onset vs adult-onset T2D. We also include an expanded section on risk factors associated with T2D, algorithms and tables for treatment, management, and assessment of co-morbidities and complications, and sections on recently approved pharmacologic therapies for the treatment of youth-onset T2D, social determinants of health, and settings of care given COVID-19 pandemic.

From Metabolic Syndrome to Type 2 Diabetes in Youth

“…Obesity, especially visceral obesity, is one of the most important risk factors for the development of T2D, whose incidence increases linearly as a function of the obesity duration [ 15 ]. Up to 85% of adolescents with T2D live with overweight or obesity, and particularly with abdominal adiposity [ 15 ].…”

“…The increased rate of inappropriate lipolysis in fasting and post-meal conditions results in an overflow of free fatty acids (FFAs) that accumulate ectopically in key metabolic organs (i.e., liver, muscle, heart, and pancreas). Adipose tissue is not just a fat storage organ but is the most expansive endocrine organ [ 15 , 18 ]. Adipose tissue can manifest low-grade inflammation and becomes fibrotic over time (“adiposopathy”).…”

“…Adipose tissue can manifest low-grade inflammation and becomes fibrotic over time (“adiposopathy”). It releases multiple adipokines in the blood flow that can impair insulin sensitivity in peripheral organs [ 15 ].…”

“…According to the International Society of Pediatric and Adolescent Diabetes (ISPAD) [ 15 ], T2D occurs in young individuals because of obesity, when insulin production becomes inadequate with respect to the increased demand due to IR (relative insulin deficiency). As said, it is usually associated with other metabolic abnormalities characterized by increased IR, i.e., dyslipidemia, hypertension, PCOS, FLD, all of which make it possible, if persistent, to be framed within the MetS.…”

ISPAD Clinical Practice Consensus Guidelines 2022: Editorial

“…3 For type 2 diabetes (T2D), follow-up of large cohorts from around the globe continue to inform the rates of co-morbidities and complications in youth-onset T2D, while pharmacologic therapies for the treatment of youth-onset T2D have expanded. 4 For monogenic diabetes, technological advances include the use of next-generation sequencing, which is now considered the best approach for early molecular diagnosis and to guide treatment, particularly for neonatal diabetes.…”