Type 2 Diabetes in Children and Adolescents. Arlan L. Rosenbloom

and without islet cell autoimmunity markers likely have ADM.

      

In obese patients, islet cell autoimmunity testing should be considered. If this is not practical, or if the patient has acanthosis nigricans, the diagnosis can usually be clarified during the first several months by reducing and, if glycemic goals obtained, stopping acutely required insulin, with weight reduction, exercise, and, as necessary, oral hypoglycemic therapy.

      Insidious Onset

      

Obese individuals who are not African American or who are African American but do not have a three-generation history of early-onset diabetes in a dominant pattern can be considered to have type 2 diabetes.

      

Islet autoantibody testing will be helpful in a lean patient. The presence of antibodies indicates type 1 diabetes picked up early; the absence of antibodies may indicate MODY.

      

Because MODY is rare, routine testing for the various mutations that have been described is not of value.

      

Fasting C-peptide or insulin measurements, if insulin treatment has not been given, may be of value after stabilization; elevated levels are indicative of type 2 diabetes. Repeat testing at 1 year or later may be needed for individuals with normal results.

      REFERENCES

      1. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 24:S5–S20, 2001

      2. Winter WE, Maclaren NK, Riley WJ, Clarke DW, Kappy MS, Spillar RP: Maturity onset diabetes of youth in black Americans. N Engl J Med 316:285–291, 1987

      3. Banerji MA, Leibovitz H: Insulin sensitive and insulin resistant variants in IDDM. Diabetes 38:784–792, 1989

      4. Banerji MA, Chaiken RL, Huey H, Tuomi T, Norin AJ, Mackay IR, et al.: GAD antibody negative NIDDM in adult black subjects with diabetic ketoacidosis and increased frequency of human leukocyte antigen DR3 and DR4: Flatbush diabetes. Diabetes 43:741–745, 1994

      5. Banerji MA: Impaired beta-cell and alpha-cell function in African-American children with type 2 diabetes mellitus: “Flatbush diabetes.” J Pediatr Endocrinol Metab 15 (Suppl. 1):493-501, 2002

      6. Winter WE, Nakamura M, House DV: Monogenic diabetes mellitus in youth: the MODY syndromes. Endocrinol Metab Clin North Am 28:765–785, 1999

      7. Doria A, Plengvidhya N: Recent advances in the genetics of maturity onset diabetes of the young and other forms of autosomal dominant diabetes. Curr Opin Endocrinol Diabetes 7:203–210, 2000

      8. Rosenbloom AL, Joe JR, Young RS, Winter WE: The emerging epidemic of type 2 diabetes mellitus in youth. Diabetes Care 22:345–354, 1999

      9. American Diabetes Association: Type 2 diabetes in children and adolescents (Consensus Statement). Diabetes Care 23:381–389, 2000

      10. Turner R, Stratton I, Horton V, Manley S, Zimmet P, Mackay IR, Shattock M, Bottazzo GF, Holman R, for the UK Prospective Diabetes Study (UKPDS) Group: UKPDS 25: autoantibodies to islet cell cytoplasm and glutamic acid decarboxylase for prediction of insulin requirement in type 2 diabetes. Lancet 350:1288–1293, 1997

      11. Landin-Olsson M: Latent autoimmune diabetes in adults. Ann N Y Acad Sci 958:112–116, 2002

      12. Hosszúfalusi N, Vatay Á, Rajczy K, Prohászka Z, Pozsonyi É, Horváth L, Grosz A, Gerõ L, Madácsy L, Romics L, Karádi I, Füst G, Pánczél P: Similar genetic features and different islet cell autoantibody pattern of latent autoimmune diabetes in adults (lada) compared with adult-onset type 1 diabetes with rapid progression. Diabetes Care 26:452–457, 2003

      13. Hathout EH, Thomas W, El-Shahawy M, Nabab F, Mace JW: Diabetic autoimmune markers in children and adolescents with type 2 diabetes. Pediatrics 107:E102, 2001

      14. Umpaichitra V, Banerji MA, Castells S: Autoantibodies in children with type 2 diabetes mellitus. J Pediatr Endocrinol Metab 15:525–530, 2002

      15. Wilkin TJ: The accelerator hypothesis. Diabetologia 44:914–922, 2001

      16. Strauss RS, Pollack HA: Epidemic increase in childhood overweight, 1986–1998. JAMA 286:2845–2848, 2001

      17. Dahlquist G, Blom L, Tuvemo T, Nystrom L, Sandstrom A, Wall S: The Swedish childhood diabetes study: results from a nine-year case register and a one-year case-referent study indicating that type 1 (insulin-dependent) diabetes mellitus is associated with both type 2 (non-insulin-dependent) diabetes mellitus and autoimmune disorders. Diabetologia 32:2–6, 1989

      18. Li H, Lindholm E, Almgren P, Gustafsson A, Forsblom C, Groop L, Tuomi T: Possible human leukocyte antigen-mediated genetic interaction between type 1 and type 2 diabetes. J Clin Endocrinol Metab 86:574–582, 2001

      19. Pinhas-Hamiel O, Dolan LM, Zeitler PS: Diabetic ketoacidosis among obese African American adolescents with NIDDM. Diabetes Care 28:484–486, 1997

      20. Sellers EAC, Dean H: Diabetic ketoacidosis: a complication of type 2 diabetes in Canadian aboriginal youth. Diabetes Care 23:1202–1204, 2000

      21. Macaluso CJ, Bauer UE, Deeb LC, Malone JI, Chaudhari M, Silverstein J, Eidson M, Arbelaez AM, Goldberg RB, Gaughan-Bailey B, Brooks RG, Rosenbloom AL: Type 2 diabetes mellitus among Florida children and adolescents, 1994 through 1998. Public Health Reports 117:373–379, 2002

      22. Morales A, Rosenbloom AL: Death at the onset of type 2 diabetes (T2DM) in African-American youth. Pediatr Res 51:124A, 2002

      C H A P T E R 3

      Epidemiology of

      Type 2 Diabetes and

      Obesity in Children

      EVIDENCE FOR AN EPIDEMIC OF TYPE 2

      DIABETES IN CHILDREN (TABLES 9–11)

      North America

      

In the Pima Indian population, in which 50% of adults have type 2 diabetes

      

in 1979, prevalence of type 2 diabetes was

      

1% (9 of 1,000) of those age 15–24 years

      

nil in those younger than 15 years (1)

      

by the 1990s, type 2 diabetes prevalence was

      

5% of those 15–19 years old (51 of 1,000)

      

2.2% of those 10–14 years old (22 of 1,000) (2)

      

First Nation population in