A narrative review of type 2 diabetes mellitus and its management in children and adolescents

Background and Objective: The rate of type 2 diabetes mellitus (T2DM) in children and adolescents has exponentially increased over the past two decades. Equally concerning is the increasing rate of childhood obesity. While the presence of childhood obesity does not infer development of T2DM, obesity does increase the inherent risk for developing obesity related co-morbidities including T2DM. This narrative aims to provide the reader with a comprehensive overview of current knowledge of T2DM in children and adolescents and its management, including update on new medications recently approved for use in this population. Methods: We conducted a PubMed search including literature in the English language using keywords: literature from reference of retrieved literature. We considered all literature published between January 2000 to July 2021. Key Content and Findings: A comprehensive overview of current knowledge, management and treatment of T2DM in children and adolescents. Conclusions: T2DM is characterized by persistent hyperglycemia in the setting of impaired glucose tolerance and relative insulin deficiency. Understanding the differences and similarities between type 1 diabetes mellitus (T1DM) and T2DM aids in proper diagnosis in youth who often have overlapping phenotypic presentation. Screening for T2DM in at risk youth is critical for timely diagnosis to ameliorate and reduce risk for development of co-morbidities that often present at time of diagnosis. Lifestyle modifications are the gold standard in the treatment and management of T2DM in children and adolescents. In recent years there has been widespread recognition that traditional management with oral medications and insulin fails to adequately treat youth with T2DM. Recent FDA approval of GLP-1 analogs for use in older children and adolescents provides clinicians additional management options, which have not only demonstrated improve glycemic control, but at higher doses, has shown clinically significant reduction in body mass index (BMI). Additionally, addressing obesity as a primary factor increasing risk and contributing to T2DM allows the provider, patient and family to consider metabolic bariatric surgery for symptom remission.