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

Table 1 Clinical and laboratory findings of type 1 and type 2 diabetes mellitus and maturity-onset diabetes of the young in children and adolescents

Parameter	T1DM	T2DM	MODY
Prevalence	Common, increasing	Rare, increasing	Rare, stable
Ethnicity	Mainly Caucasian	Mainly minority groups	All
Inheritance	Multigenic	Multigenic	Autosomal dominant
Family history	5%-10% positive for T1DM	75%-90% positive for T2DM	100% positive for MODY
Sex	Male = Female	Male < Female	Male = Female
Age at presentation	Childhood-adolescence	Adolescence	Before 25 yr of age
Body habitus	Usually normal weight	Mostly obese	Various
Acanthosis nigricans	Rare	Very common	Absent
Onset	Usually acute, severe	Usually insidious, rarely acute	Insidious
Ketosis at onset	Common	5%-10%	Rare
Insulin, C-peptide	Decreased or absent	Variable	Detectable
Insulin sensitivity	Normal	Decreased	Normal
HLA-DR3/4 association	Strong	None	None
Pancreatic autoantibodies	85%-100%	< 10%	Rare
Insulin dependence	Permanent	Variable	Rare
Associated disorders	Autoimmune disorders (e.g., Hashimoto, vitiligo, celiac disease)	MetS components (e.g., lipid disorders, hypertension, PCOS, sleep apnea, etc.)	Depending on type, may present with exocrine pancreas insufficiency, urogenital malformation, etc.

HLA: Human leukocyte antigen; MetS: Metabolic syndrome; MODY: Maturity-onset diabetes of the young; PCOS: polycystic ovary syndrome, T1DM: Type 1 diabetes mellitus; T2DM: Type 2 diabetes mellitus.

Table 2 Routine monitoring of children and adolescents with type 2 diabetes for comorbidities and chronic complications

Evaluation	Test performed	Testing frequency
Hypertension	BP measurement with appropriately-sized cuff	At the time of diagnosis and at each routine visit; more frequently if elevated
Dyslipidemia	Non-fasting or fasting lipid panel	At diagnosis once glycemic control is achieved. Annually thereafter, more frequently if abnormal
NAFLD	Liver transaminases	At diagnosis and annually thereafter
Retinopathy	Dilated eye examination or retinal imaging	At diagnosis and annually thereafter, or as per ophthalmologist’s advice
Nephropathy	In a spot specimen urine albumin-to-creatinine ratio	Repeat annually. If abnormal, repeat on at least two occasions during the next 3-6 mo
Neuropathy	Foot examination (pulses and ankle reflex); sensory testing for vibration (tuning fork) and sensation (10-g monofilament)	Repeat annually. If abnormal, refer to neurologist
Psychosocial assessment	Screen for depression, eating disorders, risk-taking behaviors, or other psychosocial dysfunction	Repeat at each routine visit or as needed. If abnormal, refer to mental health professionals

BP: Blood pressure; NAFLD: Non-alcoholic fatty liver disease.