Development of type 2 diabetes mellitus in the obese adolescent: a growing challenge

To describe the metabolic phenotype of type 2 diabetes mellitus in youth and possible metabolic defects leading to its development with particular emphasis on fatty liver.

We present data gathered from studies performed in obese adolescents across the spectrum of glucose tolerance to assess both alterations in insulin sensitivity and secretion. Discussion regarding treatment options is presented using the data from the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study.

As the number of children with obesity continues to grow, the health implications of the condition are becoming increasingly evident. An unprecedented phenomenon rarely seen before has emerged: type 2 diabetes mellitus. At the time of diabetes diagnosis, cardiovascular disease may already be present, even in young adults. The progression from normal glucose tolerance to type 2 diabetes in adults occurs through an intermediate phase of altered glucose metabolism known as impaired glucose tolerance or prediabetes. Previous studies from our group and others reported a high prevalence of impaired glucose tolerance among children and adolescents with marked obesity. Cross-sectional studies demonstrate that impaired glucose tolerance in obese youth is associated with severe insulin resistance, β-cell dysfunction, and altered abdominal and muscle fat partitioning. We end briefly by discussing the current data available on treatment of this condition from the TODAY study, the largest clinical trial ever performed in youth with type 2 diabetes.

The observed rapid progression of the glucose homeostasis alterations in adolescents underlines the importance of focusing attention on the earliest stages of the disease before the onset of any alterations in glucose tolerance.