Type 2 Diabetes in Children: Clinical Aspects and Risk Factors

Abstract

In the past, type 2 diabetes mellitus was considered a disease of adults and older individuals, not a paediatric condition. Over the last decade, however, in the USA and the rest of the world there has been a disturbing trend of increasing cases of type 2 diabetes in children, mirroring increasing rates of obesity. The risk factors for paediatric type 2 diabetes are: (1) obesity and increased body mass index; (2) family history of type 2 diabetes; (3) membership of ethnic minority; (4) puberty (mean age of diagnosis is ∼13.5 years); (5) female gender; and (6) features of ‘syndrome X’. The common link among these risk factors is insulin resistance, which plays a pivotal role in the pathophysiology of type 2 diabetes. Both insulin resistance and β-cell failure are present in the fully established diabetes state. Data will be presented on how these risk factors impact on insulin sensitivity and insulin secretion in childhood, ultimately leading to type 2 diabetes. The clinical presentation of type 2 diabetes in children and its distinction from type 1 diabetes will be discussed.

Type 2 diabetes mellitus in children and adolescents

“…Microvascular disease is the hallmark of hyperglycaemia diagnosed at a young age. Data from Japanese, Pima Indian children show the presence of microvascular diabetic complications already at diagnosis and follow-up [1] . In Japanese children, incipient retinopathy was detected in 36% of the cases at the time of diagnosis, and in 39% of the cases at 2 years follow-up, while microalbuminuria was observed in 39% at 2 years follow-up [56] .…”

“…However, in the mid-1990s, investigators began to observe an increasing incidence of type 2 diabetes mellitus worldwide [1] . This is particularly the case in the United States [1,2] but has also been reported in other countries like Canada, Japan, Austria, United Kingdom and Germany [3][4][5][6][7][8][9][10] . In some regions in the United States, type 2 diabetes mellitus is as frequent as type 1 diabetes mellitus in adolescents [11] .…”

Childhood obesity: a pandemic of the twenty-first century

“…17 In Europe, although less common, it is present in ethnic minorities but also reported in obese Caucasian adolescents, mostly girls with positive family history for T2DM. 8 Metabolic syndrome (MS) is being identified in up to 30% of obese children.…”

Metabolic Syndrome among Obese Kuwaiti Adolescents (11-17 Years)

“…Over the past 10 years, the rate of obesity and over weight has been increased in Kuwaiti children and adolescents [9]. Obesity is associated with dyslipidaemia, type 2 diabetes mellitus and long-term vascular complications [10][11][12][13].…”