Type 2 diabetes in children -: An emerging clinical problem

In parallel with the rising prevalence of overweight and obesity, there is an increase in the number of obesity-associated type 2 diabetes cases in childhood and adolescence. It seems to be a worldwide phenomenon affecting mainly some ethnic and minority populations. Screening studies in groups of obese children and analyses of childhood diabetes clinics have demonstrated that in contrast to North America, the prevalence of type 2 diabetes in children in Europe has not yet reached epidemic proportions. Screening (measurement of fasting blood glucose and OGTT) can be recommended for obese children with additional risk factors and signs of insulin resistance. Clinical presentation is varied with incidental diagnosis (silent type 2) and severe ketoacidosis at the two ends of the spectrum. Treatment depends on the severity of the clinical manifestation. Milder cases can be treated by lifestyle modification and metformin, insulin is the treatment of choice in severe cases. Growing evidence in adult patients suggests that introduction of insulin early improves long-term glycacmic control. There are no sufficient paediatric data on the use of sulfortylureas, meglitinides, thiazolidinediones and GLP1 agonists. (c) 2006 Elsevier Ireland Ltd. All rights reserved.