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Pathophysiology of Type 2 Diabetes Mellitus in Children and Adolescents

Treatment Implications

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Treatments in Endocrinology

Abstract

Type 2 diabetes mellitus was considered an exclusive disease of adulthood until the late 1970s, when reports of an increased prevalence in the pediatric age group emerged in the literature. The concerning upswing in the rate of diagnosis of type 2 diabetes mellitus in children and adolescents has continued, parallel to the increasing rates of obesity. The disease is not specific to the US; it has proven to be a global problem.

The current information on type 2 diabetes mellitus in children and adolescents is mostly extrapolated from studies in adults with type 2 diabetes mellitus, due to the paucity of studies conducted in youth. Obesity, family history of type 2 diabetes mellitus, minority ethnicity and race, polycystic ovary syndrome, maternal diabetes mellitus or impaired glucose tolerance during gestation, and acanthosis nigricans are the major risk factors and markers of youth-onset type 2 diabetes mellitus. The pathophysiology, which involves both an insulin secretion defect and resistance to insulin, needs further clarification in pediatric studies.

Current management approaches involve lifestyle modification (nutritional and exercise) along with pharmacologic agents, such as insulin and oral antihyperglycemic medications, as indicated. A recent study on the use of metformin in childhood-onset type 2 diabetes mellitus demonstrated the drug to be effective and to have a good safety profile in this population. However, the outcomes of ongoing studies and future studies focusing on type 2 diabetes mellitus in the pediatric age group will be crucial in terms of fine-tuning management plans and setting up appropriate prevention strategies.

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Acknowledgements

This work was supported by United States Public Health Service grant RO1 HD27503, K24 HD01357, MO1 RR00084 General Clinical Research Center, Renziehausen Trust Fund, Bristol Myers Squibb, and Eli Lilly and Company.

The authors thank Ms Michelle Beckwith and Mrs Pat Antonio for their secretarial assistance.

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  1. Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, Children’s Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

    Neslihan Gungor &  Silva Arslanian

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Gungor, N., Arslanian, S. Pathophysiology of Type 2 Diabetes Mellitus in Children and Adolescents. Treat Endocrinol 1, 359–371 (2002). https://doi.org/10.2165/00024677-200201060-00002

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