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Type 2 diabetes in children: clinical aspects and risk factors
1Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, Children's Hospital, University of Pittsburgh, Pa 15213, USA. arslans@chplink.chp.edu
Insights
Type 2 diabetes is increasingly diagnosed in children, linked to rising obesity rates. Key risk factors include obesity, family history, and puberty, all associated with insulin resistance.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Public Health
Background:
- Type 2 diabetes mellitus was historically considered an adult disease.
- Recent decades show a concerning rise in pediatric type 2 diabetes cases globally, paralleling increased obesity.
- This trend necessitates understanding the unique risk factors and pathophysiology in children.
Purpose of the Study:
- To examine the risk factors contributing to type 2 diabetes in children.
- To elucidate the role of insulin resistance and beta-cell function in pediatric type 2 diabetes.
- To differentiate the clinical presentation of type 2 diabetes from type 1 diabetes in pediatric populations.
Main Methods:
- Review of epidemiological data on pediatric type 2 diabetes trends.
- Analysis of risk factors such as obesity, family history, ethnicity, puberty, and gender.
- Discussion of the pathophysiology involving insulin resistance and beta-cell dysfunction.
- Comparison of clinical features between pediatric type 2 and type 1 diabetes.
Main Results:
- Obesity and increased body mass index are primary risk factors for pediatric type 2 diabetes.
- Family history, minority ethnicity, puberty, and female gender are significant contributing factors.
- Insulin resistance is the central mechanism linking these risk factors to the disease.
- Both insulin resistance and beta-cell failure are evident in established cases.
Conclusions:
- Paediatric type 2 diabetes is a growing concern driven by modifiable risk factors like obesity.
- Understanding insulin resistance is crucial for managing and preventing type 2 diabetes in children.
- Distinguishing type 2 from type 1 diabetes in children is essential for appropriate clinical management.
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 approximately 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 beta-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.