Type 2 diabetes in children and adolescents: Exploring the disease heterogeneity and research gaps to optimum management

Abstract

Over the past 20 years, the incidence and prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents have increased, particularly in racial and ethnic minorities. Despite the rise in T2DM in children and adolescents, the pathophysiology and progression of disease in this population are not clearly understood. Youth-onset T2DM has a more adverse clinical course than is seen in those who develop T2DM in adulthood or those with T1DM. Furthermore, the available therapeutic options are more limited for children and adolescents with T2DM compared to adult patients, mostly due to the challenges of implementing clinical trials. A better understanding of the mechanisms underlying the de-velopment and aggressive disease phenotype of T2DM in youth is important to finding effective prevention and management strategies. This review highlights the key evidence about T2DM in children and adolescents and its current burden and challenges both in clinical care and research activities.

Keywords: Type 2 diabetes mellitus; Children and adolescents; Pathophysiology; Heterogeneity; Complications; Treatment options; Barriers

Core Tip: The incidence and prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents have dramatically increased over the past 20 years. Accumulating evidence suggests that youth-onset T2DM presents unique characteristics, demographics, and disease progression compared to adult-onset T2DM. In addition, the available therapeutic options for children and adolescents with T2DM are inadequate. T2DM in children and adolescents is becoming a public health concern worldwide. Research programs should aim to overcome the challenges seen with clinical studies in this population to address the unmet need of optimal management of T2DM in children and adolescents.