Type 2 diabetes mellitus (T2DM) is emerging as a new clinical problem within pediatric practice. Recent reports indicate an increasing prevalence of T2DM in children and adolescents around the world in all ethnicities, even if the prevalence of obesity is not increasing any more. There are great differences in T2DM prevalence worldwide. The majority of young people diagnosed with T2DM was found in specific ethnic subgroups such as African-American, Hispanic, Asian/Pacific Islanders, and American Indians. Clinicians should be aware of the frequent mild or asymptomatic manifestation of T2DM in childhood. Therefore, a screening seems meaningful especially in high risk groups such as children and adolescents with obesity, relatives with T2DM, and clinical features of insulin resistance (hypertension, dyslipidemia, polycystic ovarian syndrome, or acanthosis nigricans). However, there is an ongoing discussion whether and how to screen for T2DM (oGTT and HbA1c). The prospective value of impaired glucose tolerance in adolescence is low since the majority of obese adolescents demonstrated a normalization of impaired glucose tolerance after end of puberty. Treatment of choice is lifestyle intervention followed by pharmacological treatment (e.g. metformin). New drugs such as dipeptidyl peptidase inhibitors or glucagon like peptide 1 mimetics are in the pipeline for treatment of youth with T2DM. Furthermore bariatric surgery is proposed as a therapeutic option especially in extreme obese adolescents with T2DM. Recent reports indicate a high dropout of the medical care system of adolescents with T2DM suggesting that management of children and adolescents with T2DM requires some remodeling of current healthcare practices.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology