Diagnosis, treatment and prevention of type 2 diabetes mellitus in children and adolescents

Abstract

During the last two decades, there have been several reports of an increasing incidence of type 2 diabetes mellitus (T2DM) in children and adolescents, especially among those belonging to minority ethnic groups. This trend, which parallels the increases in prevalence and degree of pediatric obesity, has caused great concern, even though T2DM remains a relatively rare disease in children. Youth T2DM differs not only from type 1 diabetes in children, from which it is sometimes difficult to differentiate, but also from T2DM in adults, since it appears to be an aggressive disease with rapidly progressive β-cell decline, high treatment failure rate, and accelerated development of complications. Despite the recent research, many aspects of youth T2DM still remain unknown, regarding both its pathophysiology and risk factor contribution, and its optimal management and prevention. Current management approaches include lifestyle changes, such as improved diet and increased physical activity, together with pharmacological interventions, including metformin, insulin, and the recently approved glucagon-like peptide-1 analog liraglutide. What is more important for everyone to realize though, from patients, families and physicians to schools, health services and policy-makers alike, is that T2DM is a largely preventable disease that will be addressed effectively only if its major contributor (i.e., pediatric obesity) is confronted and prevented at every possible stage of life, from conception until adulthood. Therefore, relevant comprehensive, coordinated, and innovative strategies are urgently needed.

Keywords: Type 2 diabetes; Children; Adolescents; Diagnosis; Treatment; Prevention

Core Tip: Type 2 diabetes mellitus (T2DM) incidence has increased among children and adolescents during the last two decades, especially for minority groups. Youth T2DM is an aggressive disease, associated with high treatment failure rate and early complications. It can be differentiated from type 1 diabetes in obese youth presenting with hyperglycemia, by using both clinical and laboratory clues. T2DM management is based upon the combined application of lifestyle interventions and pharmacological treatments. Nevertheless, prevention seems to be the only way to effectively deal with this disease and this requires preventing pediatric obesity starting as early as before birth and extending throughout childhood.